Vaccine compositions comprising tryptophan 2,3-dioxygenase or fragments thereof

ABSTRACT

The invention relates to prophylaxis and therapy of cancer. In particular there is provided a protein Tryptophan2,3-di-oxygenase (TDO) or peptide fragments here of that are capable of eliciting anti-cancer immune responses. Specifically, the invention relates to the use of TDO or peptides derived thereof or TDO specific T-cells for treatment of cancer. The invention thus relates to an anti-cancer vaccine which optionally may be used in combination with other immunotherapies and to TDO specific T-cells adoptively transferred or induced in vivo by vaccination as a treatment of cancer. It is an aspect of the invention that the medicaments herein provided may be used in combination with cancer chemotherapy treatment. A further aspect relates to the prophylaxis and therapy of infections by the same means as described above.

FIELD OF INVENTION

The present invention relates to the field of prophylaxis and therapy ofcancer. In particular there is provided a protein Tryptophan2,3-dioxygenase (TDO) or peptide fragments here of that are capable ofeliciting anti-cancer immune responses. Specifically, the inventionrelates to the use of TDO or peptides derived thereof or TDO specificT-cells for treatment of cancer. The invention thus relates to ananti-cancer vaccine which optionally may be used in combination withother immunotherapies and to TDO specific T-cells adoptively transferredor induced in vivo by vaccination as a treatment of cancer. It is anaspect of the invention that the medicaments herein provided may be usedin combination with cancer chemotherapy treatment. A further aspectrelates to the prophylaxis and therapy of infections by the same meansas described above.

The use of TDO and immunogenic peptide fragments hereof in cancer andinfection treatment, diagnosis and prognosis is also provided.

BACKGROUND OF INVENTION

The immune system is tightly controlled to avoid the occurrence ofautoimmunity when responding to various pathogens. This enantiostasis,allowing at the same time destruction of infected or transformed cellsand self-tolerance, is guarded by several feedback mechanisms.Unfortunately, some of the mechanisms preventing auto-immunity arehijacked by cancers to attain immune escape. This evasion of immunedestruction is based on several mechanisms including depletion ofessential nutrients as well as accumulation of immunosuppressivemetabolites. Thus, metabolic changes within the tumor microenvironmenthelp to evade antigenic specific immune responses. In this respect,aberrations of the metabolism of the essential amino acid L-tryptophanhave been described in various cancers. Notably, controlling the levelof tryptophan is an important part of the host defense against invadingpathogens as microbes need high concentrations of available tryptophanfor optimal growth.

The degradation of L-(and D-) tryptophan to N-formylkynurenine iscatalyzed by the heme dioxygenases tryptophan 2,3-dioxygenase (TDO) andindoleamine 2,3-dioxygenase (IDO). TDO and IDO do not share sequencehomology. Although by distinct mechanisms, both TDO and IDO catalyze thefirst and rate-limiting step of tryptophan oxidation yieldingkynurenine. Moreover, as IDO is upregulated by inflammatory cytokinessuch as type I and II interferon's, it is thought to be an importantcounter-regulatory enzyme, which controls disproportionate immuneresponses.

The impact of tryptophan metabolism on immune responses is wellestablished. T cells sense low levels of tryptophan via theserine/threonine-protein kinase GCN2, which is then triggeringproliferative arrest. Moreover, the tryptophan degradation productkynurenine binds the aryl hydrocarbon receptor (AHR); activation of AHRsignaling induces formation of regulatory T cells.

Little is known about the function of TDO in cancer. Under physiologicconditions TDO is almost exclusively expressed at high amounts in theliver and—in lower levels—in the brain. Recently, it was described thattumors of different origin express TDO, especially melanoma, bladdercancer, hepatocellular carcinoma and glioblastoma (Pilotte et al.,2012). In a series of 104 human tumor cell lines of various histologicaltypes, 20 tumors expressed only TDO, 17 only IDO and 16 both enzymes(Pilotte et al., 2012). Moreover, in a preclinical model, TDO expressionby tumors prevented their rejection by immunized mice (Pilotte et al.,2012).

SUMMARY OF INVENTION

The expression of TDO and the potential TDO induced cancerimmunosuppression poses a problem in the treatment of cancer.

The problem of cancer immunosuppression is solved by the presentinvention, which provides TDO as a novel T cell target. Instead ofinhibiting the function of TDO, the present invention provides peptidesand compositions capable of activating TDO-specific T-cells, whichrecognizes cells expressing TDO.

Thus, the present invention provides materials and methods for treatmentof cancer diseases by targeting TDO expressing cancer cells directly andby killing TDO expressing cancer cells. This is done by enabling T cellsto recognize the TDO expressing cells. Interestingly, the presentinvention discloses that cytotoxic immune responses against TDOexpressing cells can be raised even though TDO expressing cells mayantagonize the desired effects of other immunotherapeutic approaches.

Likewise, the invention provides materials and methods for treatment ofother diseases, which normally may invoke an immune response, e.g.infections. In the methods of the invention T cells are enabled to killTDO expressing APCs/DCs.

Thus, the invention exploits expression of the immune suppressing enzymeTDO in cancer cells and targets these TDO expressing cells.

Interestingly, the present invention demonstrates that T cellsspecifically recognizing TDO can be found in healthy individuals (seeExample 1 below). This indicates a loss of tolerance to the self-proteinTDO. The invention takes advantage of this loss of tolerance to TDO, andit is thus an aspect of the invention to provide vaccine compositionswhich surprisingly can generate an immune response against theself-protein TDO.

The present invention provides vaccine compositions comprising

-   -   a) one or more of the following:        -   (i) tryptophan 2,3-dioxygenase (TDO) of SEQ ID NO:1;        -   (ii) an immunogenically active peptide fragment of TDO            comprising a consecutive sequence of amino acids of TDO of            SEQ ID NO:1;        -   (iii) an immunogenially active peptide fragments of TDO,            which is an MHC Class I-restricted peptide fragment or MHC            Class II-restricted peptide fragment;        -   (iv) a functional homologue of the polypeptides under            (i), (ii) and (iii), wherein said functional homologue            shares at least 70% sequence identity with SEQ ID NO:1            and/or said functional homologue is an immunogenically            active polypeptide consisting of a sequence identical to a            consecutive sequence of amino acids of SEQ ID NO:1, except            that at the most three amino acids have been substituted;        -   (v) a polypeptide comprising any of the polypeptides under            (i), (ii), (iii) or (iv);        -   (vi) a nucleic acid encoding any of the polypeptides under            1), 2), 3) and 4); and    -   b) an adjuvant.

The vaccine compositions may be used as a medicament, and may forexample be for treatment of a cancer disease where TDO is expressed orfor treatment of an infection causing TDO expression in APCs.

The invention also provides kit-of-parts comprising the vaccinecomposition and a second active ingredient.

The invention also provides compositions for ex vivo or in situdiagnosis of the presence in an individual suffering from a clinicalcondition of T cells in PBL or in tumor tissue that is reactive withTDO, the composition comprising a peptide fragment of TDO, e.g. any ofthe peptide fragments of TDO described herein below in the sections“Immunogenically active peptide fragment of TDO”, “Polypeptidecomprising TDO or a fragment thereof” and “MHC”.

The invention further provides diagnostic kits for ex vivo or in situdiagnosis of the presence in an individual suffering from a clinicalcondition of T cells in PBL or in tumor tissue that is reactive withTDO, the kit comprising a peptide fragment of TDO, e.g. any of thepeptide fragments of TDO described herein below in the sections“Immuno-genically active peptide fragment of TDO”, “Polypeptidecomprising TDO or a fragment thereof” and “MHC”.

The invention also describes complexes of a peptide fragment of TDO anda Class I HLA or a Class II HLA molecule or a fragment of such molecule.Said peptide fragment may e.g. be any of the peptide fragments of TDOdescribed herein below in the sections “Immunogenically active peptidefragment of TDO”, “Polypeptide comprising TDO or a fragment thereof” and“MHC”.

The invention further discloses methods of detecting in an individualsuffering from a clinical condition the presence of TDO reactiveT-cells, the method comprising contacting a tumor tissue or a bloodsample with the complex comprising peptide fragments of TDO describedabove and detecting binding of the complex to the tissue or the bloodcells.

The invention also discloses molecules that are capable of bindingspecifically to a peptide fragment of TDO e.g. be any of the peptidefragments of TDO described herein below in the sections “Immunogenicallyactive peptide fragment of TDO”, “Polypeptide comprising TDO or afragment thereof” and “MHC”.

The invention also provides methods of treating a clinical conditioncharacterized by the expression of TDO, the method comprisingadministering to an individual suffering from said clinical condition aneffective amount of the vaccine compositions of the invention, of akit-of-parts of the invention, of a composition of the invention and/orof an immunogenically active peptide fragment of TDO, e.g. be any of thepeptide fragments of TDO described herein below in the sections“Immunogenically active peptide fragment of TDO”, “Polypeptidecomprising TDO or a fragment thereof” and “MHC”.

The invention also provides use of the vaccine compositions of theinvention in the manufacture of a medicament for the treatment orprevention of a clinical condition, e.g. cancer and/or inflammations.

The invention also provides methods of monitoring immunization, saidmethod comprising the steps of

-   -   c) providing a blood sample from an individual    -   d) providing TDO of SEQ ID NO:1 or a functional homologue        thereof having at least 70% identity thereto or an        immunogenically active peptide fragment comprising a consecutive        sequence of said TDO or said functional homologue thereof or a        nucleic acid encoding said TDO or said peptide fragment.    -   e) determining whether said blood sample comprises antibodies or        T-cells comprising T-cell receptors specifically binding the        protein or peptide    -   f) thereby determining whether an immune response to said        protein or peptide has been raised in said individual.

Further, the invention provides immunogenically active TDO peptidefragments comprising a consecutive sequence of TDO of SEQ ID NO:1 or afunctional homologue thereof, said functional homologue being apolypeptide of identical sequence except that at the most three aminoacids have been substituted, or a nucleic acid encoding said TDO peptidefragment for use in the treatment or prevention of clinical conditionsassociated with expression of TDO, such as cancer and/or infections.

DESCRIPTION OF DRAWINGS

FIG. 1 shows natural T-cell responses against TDO. (A), In order todetect TDO-specific CD8⁺ T-cell responses, 15 predicted HLA-A2restricted T-cell epitopes were synthesized to examine peripheral bloodmononuclear cells (PBMC) from six, HLA-A2⁺ cancer patients. PBMC sampleswere stimulated once in vitro with peptide and IL-2 for one week beforebeing plated in an IFNγ ELISPOT assay at 5×10⁵ cells per well intriplicates with or without a relevant TDO peptide. The average numberof TDO-specific, IFNγ-releasing cells was calculated per 5×10⁵ PBMC.IFNγ ELISPOT responses against TDO₁₂₃₋₁₃₂ (KLLVQQFSIL) were examined in14 cancer patients and 14 healthy donors. T cells were stimulated oncewith peptide before being plated in an IFNγ ELISPOT assay at 3×10⁵ cellsper well in triplicates with the TDO₁₂₃₋₁₃₂ (B), TDO₂₀₀₋₂₀₈ (D),TDO₃₀₉₋₃₁₇ (F), TDO₃₆₄₋₃₇₂ (H), or a negative control peptide(HIV_(pol476-484) (ILKEPVHGV)). The dot plots designate mean spot countof triplicate positive wells with subtraction of background. Examples ofELISPOT experiments against TDO₁₂₃₋₁₃₂ (C), TDO₂₀₀₋₂₀₈ (E), TDO₃₀₉₋₃₁₇(G), TDO₃₆₄₋₃₇₂ (I), and HIV_(pol476-484) in PBMC from different cancerpatients or healthy donors.

FIG. 2 shows expansion of TDO-specific CD8⁺ T cells. Tetramer analysisof TDO-specific T-cells; Examples of TDO₁₂₃₋₁₃₂-(A) or TDO₃₀₉₋₃₁₇ (B)-specific CD8⁺ T-cells among PBMC from a breast cancer patient (BC1) asvisualised by flow cytometry staining using the tetramersHLA-A2/TDO₁₂₃₋₁₃₂-PE, HLA-A2/TDO₁₂₃₋₁₃₂-APC. The stainings wereperformed directly ex vivo (left), after peptide stimulations in vitro(middle), and after sorting and expansion of tetramer-positive cells byFACS (right).

FIG. 3 shows cytolytic capacity of TDO-specific T cells. (A), The lysisof T2-cells pulsed with either relevant TDO₁₂₃₋₁₃₂ peptide (dots) or anirrelevant TDO peptide TDO₃₀₉₋₃₁₇ (squares) by the TDO₁₂₃₋₁₃₂-specificT-cell culture as examined by ⁵¹Cr-release assay. X-axis designateeffector:target ratio. (B), Lysis by TDO₁₂₃₋₁₃₂-specific T cells of theHLA-A2⁺ melanoma cell lines FM-55M1 and FM-86, the breast cancer cellline MDA-MB 231, and the AML cell line UKE-1 at different effector totarget ratios as assayed by ⁵¹Cr-release. In addition the Melanoma cellline A2058 (HLA-A2 negative) was examined as negative control. (C) Thelysis of T2-cells pulsed with either relevant TDO₃₀₉₋₃₁₇ peptide(squares) or an irrelevant TDO peptide TDO₁₂₃₋₁₃₂ (dots) by theTDO₃₀₉₋₃₁₇-specific T-cell culture as examined by ⁵¹Cr-release assay.(D), Lysis by TDO₃₀₉₋₃₁₇ -specific T cells of the HLA-A2⁺ melanoma celllines FM-55M1 and FM-86, the breast cancer cell line MDA-MB 231, and theAML cell line UKE-1 at different effector to target ratios as assayed by⁵¹Cr-release. In addition the Melanoma cell line A2058 (HLA-A2 negative)was examined as negative control.

FIG. 4 shows A ELISPOT responses against autologous dendritic cellstransfected with TDO mRNA or Mock as well as control wells with additionof only peptides TDO₁₂₃₋₁₃₂ or TDO₃₀₉₋₃₁₇. B cytotoxicity of theTDO₁₂₃₋₁₃₂ specific IL2 expanded T cell cultures against T2 cells loadedwith TDO₁₂₃₋₁₃₂, TDO₃₀₉₋₃₁₇ or the corresponding long peptidesTDO₁₁₈₋₁₃₇ and TDO₃₀₃₋₃₂₂, respectively. Short peptides were addedimmediately before the assay and longer peptides were added the nightbefore. X-axis denote Effector:target ratio.

FIG. 5 shows natural CD4⁺ T-cell responses against TDO in healthy andcancer patients. T-cell responses against TDO₁₁₈₋₁₃₇ (A, C, E, G), orTDO₃₀₃₋₃₂₂ (B, D, F, H) were measured by IFNγ (A, B), TNFα (C, D), IL-17(E, F) or IL-10 (G, H) ELISPOT. The average number of TDO-specific cellsfrom triplicate experiments (after subtraction of background) wascalculated per 5×10⁵ PBMC for each patient. PBMC from 19 healthyindividuals (HD), 21 cancer patients (Pt) (twenty patients with MM andone BC) were analyzed. Only p-values (p<0,05) by a Mann-Whitney test arerevealed.

FIG. 6 shows clinical course of the examined melanoma patients. (A),Kaplan Meier estimate of OS defiend as date of blood sample to date ofdeath for melanoma patients with TDO₃₀₃₋₃₂₂-specific IL-17-releasing Tcells (dottet line) and for melanoma patients withoutTDO₃₀₃₋₃₂₂-specific IL-17 T cells (solid line). (B), Kaplan Meierestimate of OS defined as date of blood sample to date of death formelanoma patients with TDO₃₀₃₋₃₂₂-specific IL-10-releasing T cells(dottet line) and for melanoma patients without TDO₃₀₃₋₃₂₂-specificIL-10 T cells (solid line). (C), Kaplan Meier estimate of OS defined asdate of blood sample to date of death for melanoma patients withTDO₃₀₃₋₃₂₂-specific IL-17-releasing T cells without IL-10 releasingcells (dottet line) and for melanoma patients with TDO₃₀₃₋₃₂₂-specificIL-10 T cells without IL-17 releasing cells (solid line).

FIG. 7 shows examples of statistically significant TDO responses shownby ELISPOT. The non-parametric distribution free resampling (DFR) methodallowed statistical comparison of antigen-stimulated wells and negativecontrol. The bars represent mean spot count in wells with controlpeptide (HIVpol₄₆₈₋₄₇₆) (white) or a TDO-derived peptide (black) for (A)TDO₁₂₃₋₁₃₂, (B) TDO_(200-208,) (C) TDO₃₀₉₋₃₁₇, (D) TDO₃₆₄₋₃₇₂ (black).Error bars represent standard deviation. The cell numbers were 3*10⁵cells/well.

FIG. 8 shows responses towards TDO-derived peptides are detectabledirectly ex vivo. Ex vivo IFNγ ELISPOT in response to TDO₁₂₃₋₁₃₂(black), TDO₂₀₀₋₂₀₈ (dark gray) and TDO₃₀₉₋₃₁₇ (light gray) in PBMC fromdifferent cancer patients. All experiments were performed intriplicates. The cell numbers were 9*10⁵ cells/well.

DETAILED DESCRIPTION OF THE INVENTION

It is a major objective of the present invention to provide a vaccinecomposition comprising Tryptophan 2,3-dioxygenase (TDO) or animmunologically active polypeptide fragment hereof, polyppetidescomprising same or nucleic acids encoding same for use as a medicamentin the prevention of, reduction of risk of, or treatment of anyprolifereative disorder, such as cancer .

Definitions

Adjuvant: Any substance whose admixture with an administered immunogenicdeterminant/antigen/nucleic acid construct increases or otherwisemodifies the immune response to said determinant.

Antigen: Any substance that can bind to a clonally distributed immunereceptor (T-cell or B-cell receptor). Usually a peptide, polypeptide ora multimeric polypeptide. Antigens are preferably capable of elicitingan immune response.

APC: Antigen-presenting cell. An APC is a cell that displays foreignantigen complexed with MHC on its surface. T-cells may recognize thiscomplex using their T-cell receptor (TCR). APCs fall into twocategories: professional, (of which there are three types: Dendriticcells, macrophages and B-cells) or non-professional (does notconstitutively express the Major histocompatibility complex proteinsrequired for interaction with naive T cells; these are expressed onlyupon stimulation of the non-professional APC by certain cytokines suchas IFN-γ).

Boost: To boost by a booster shot or dose is to administer an additionaldose of an immunizing agent, such as a vaccine, administered at a timeafter the initial dose to sustain the immune response elicited by theprevious dose of the same agent.

Carrier: Entity or compound to which antigens are coupled to aid in theinduction of an immune response.

Chimeric protein: A genetically engineered protein that is encoded by anucleotide sequence made by a splicing together of two or more completeor partial genes or a series of (non)random nucleic acids.

Clinical condition: A condition that requires medical attention, hereinespecially conditions associated with the expression of TDO. Examples ofsuch conditions include: proliferative disorders, such as cancers andinfections.

Complement: A complex series of blood proteins whose action“complements” the work of antibodies. Complement destroys bacteria,produces inflammation, and regulates immune reactions.

CTL: Cytotoxic T lymphocyte. A sub group of T-cells expressing CD8 alongwith the T-cell receptor and therefore able to respond to antigenspresented by class I molecules. Delivery vehicle: An entity whereby anucleotide sequence or polypeptide or both can be transported from atleast one media to another.

DC: Dendritic cell. (DCs) are immune cells and form part of themammalian immune system. Their main function is to process antigenmaterial and present it on the surface to other cells of the immunesystem, thus functioning as antigen-presenting cells (APCs).

Fragment: is used to indicate a non-full length part of a nucleic acidor polypeptide.

Thus, a fragment is itself also a nucleic acid or polypeptide,respectively.

Functional homologue: A functional homologue may be any polypeptide thatexhibits at least some sequence identity with a wild type version of apolypeptide and has retained at least one aspect of the originalfunctionality. Herein a functional homologue of TDO is a polypeptidesharing at least some sequence identity with TDO and which has thecapability to induce an immune response to cells expressing TDO. Afunctional homologue of an immunogenically active peptide fragment ofTDO is a peptide sharing at least some sequence identity with a peptidefragment of TDO and which has the capability to induce an immuneresponse to cells expressing TDO.

Immunogenically active peptide: Peptide capable of eliciting an immuneresponse in at least one individual after administration to saidindividual.

Individual: Generally any species or subspecies of bird, mammal, fish,amphibian, or reptile, preferably a mammal, most preferably a humanbeing.

Infection: Herein the term “infection” relates to any kind of clinicalcondition involving an invasion of the host organism by disease-causingagents. In particular, infection refers to a clinical conditioninvolving invasion of an individual by a pathogen.

Isolated: used in connection with nucleic acids, polypeptides, andantibodies disclosed herein ‘isolated’ refers to these having beenidentified and separated and/or recovered from a component of theirnatural, typically cellular, environment. Nucleic acids, polypeptides,and antibodies of the invention are preferably isolated, and vaccinesand other compositions of the invention preferably comprise isolatednucleic acids, polypeptides or isolated antibodies.

MHC: Major histocompatibility complex, two main subclasses of MHC, ClassI and Class II exist.

Nucleic acid: A chain or sequence of nucleotides that convey geneticinformation. In regards to the present invention the nucleic acid isgenerally a deoxyribonucleic acid (DNA).

Nucleic acid construct: A genetically engineered nucleic acid. Typicallycomprising several elements such as genes or fragments of same, cDNAs,promoters, enhancers, terminators, polyA tails, linkers, polylinkers,operative linkers, multiple cloning sites (MCS), markers, STOP codons,other regulatory elements, internal ribosomal entry sites (IRES) orothers.

Operative linker: A sequence of nucleotides or amino acid residues thatbind together two parts of a nucleic acid construct or (chimeric)polypeptide in a manner securing the biological processing of thenucleic acid or polypeptide.

Pathogen: a specific causative agent of disease, especially a biologicalagent such as a virus, bacteria, prion or parasite that can causedisease to its host, also referred to as an infectious agent.

PBL: Peripheral blood cells are the cellular components of blood,consisting of red blood cells, white blood cells, and platelets, whichare found within the circulating pool of blood and not sequesteredwithin the lymphatic system, spleen, liver, or bone marrow.

PBMC: A Peripheral Blood Mononuclear Cell (PBMC) is a blood cell havinga round nucleus, such as a lymphocyte or a monocyte. These blood cellsare a critical component in the immune system to fight infection andadapt to intruders. The lymphocyte population consists of T cells (CD4and CD8 positive ˜75%), B cells and NK cells (˜25% combined).

Polypeptide: Plurality of covalently linked amino acid residues defininga sequence and linked by amide bonds. The term is used analogously witholigopeptide and peptide. The term polypeptide also embracespost-translational modifications introduced by chemical orenzyme-catalyzed reactions, as are known in the art. The term can referto a variant or fragment of a polypeptide.

Pharmaceutical carriers: also termed excipients, or stabilizers arenon-toxic to the cell or individual being exposed thereto at the dosagesand concentrations employed. Often the pharmaceutical carrier is anaqueous pH buffered solution. Examples of pharmaceutical carriersinclude buffers such as phosphate, citrate, and other organic acids;antioxidants including ascorbic acid; low molecular weight (less thanabout 10 residues) polypeptide; proteins, such as serum albumin,gelatin, or immunoglobulins; hydrophilic polymers such aspolyvinylpyrrolidone; amino acids such as glycine, glutamine,asparagine, arginine or lysine; monosaccharides, disaccharides, andother carbohydrates including glucose, mannose, or dextrins; chelatingagents such as EDTA; sugar alcohols such as mannitol or sorbitol;salt-forming counterions such as sodium; and/or nonionic surfactantssuch as TWEEN.™., polyethylene glycol (PEG), and PLURONICS.™.

Plurality: At least two.

Proliferative disorder: Herein any preneoplastic or neoplastic disease,benign or malignant, where “neoplastic” refers to an abnormalproliferation of cells. A non-limiting example of a proliferativedisorder is cancer.

Promoter: A binding site in a DNA chain at which RNA polymerase binds toinitiate transcription of messenger RNA by one or more nearby structuralgenes.

Signal peptide: A short sequence of amino acids that determine theeventual location of a protein in the cell, also referred to as sortingpeptide.

Surfactant: A surface active agent capable of reducing the surfacetension of a liquid in which it is dissolved. A surfactant is a compoundcontaining a polar group which is hydrophilic and a non-polar groupwhich is hydrophobic and often composed of a fatty chain.

TDO: Tryptophan 2,3-dioxygenase. Wild type human TDO is identifiedherein as SEQ ID NOs: 1.

TDO_(xxx-yyy): As used herein this nomenclature refers to a polypeptidefragment of TDO consisting of amino acid xxx-yyy of SEQ ID NO:1.

Treg: Regulatory T cells/T lymphocytes

Treatment: The term “treatment” as used herein may refer to curativetreatment and/or to ameliorating treatment and/or to treatment reducingsymptoms of disease and/or treatment delaying disease progression.

Vaccine: A substance or composition capable of inducing an immuneresponse in an individual, and in particularly in a mammal, preferablyin a human being. Also referred to as an immunogenic composition in thepresent text. An immune response against an agent is a humoral, antibodyand/or cellular response inducing memory in an organism, resulting inthat said agent is being met by a secondary rather than a primaryresponse, thus reducing its impact on the host organism. Said agent maybe pathogen. In the context of the present invention the agent ispreferably a cancer cell. A vaccine of the present invention may begiven as a prophylaxis, in order to reduce the risk of encountering aclinical condition and/or as a therapeutic medicament for treatment of aclinical condition. The composition may comprise one or more of thefollowing: antigen(s), nucleic acid constructs encoding one or moreantigens, carriers, adjuvants and pharmaceutical carriers.

Variant: a ‘variant’ of a given reference nucleic acid or polypeptiderefers to a nucleic acid or polypeptide that displays a certain degreeof sequence homology/identity to said reference nucleic acid orpolypeptide but is not identical to said reference nucleic acid orpolypeptide.

Vaccine Composition

It is one of aspect of the present invention to provide a vaccinecomposition comprising one or more of the following:

-   -   1) Tryptophan 2,3-dioxygenase (TDO), which may be any of the        TDOs described herein below in the section “Tryptophan        2,3-dioxygenase”;    -   2) An immunogenically active peptide fragment of TDO comprising        a consecutive sequence of amino acids of TDO, which may be any        of the peptides described herein below in the section        “Immunogenically active peptide fragment of TDO”.    -   3) An immunogenially active peptide fragments of TDO, which is        an MHC Class I-restricted peptide fragment or MHC Class        II-restricted peptide fragment, such as any of the an MHC Class        I-restricted peptide fragments or MHC Class II-restricted        peptide fragments described in the section “MHC”;    -   4) A functional homologue of the polypeptides under 1), 2) and        3);    -   5) A polypeptide comprising any of polypeptides under 1), 2), 3)        and 4), which may be any of the polypeptides described herein        below in the section “Polypeptides comprising TDO or a fragment        thereof”;    -   6) A nucleic acid encoding any of the polypeptides under 1),        2), 3) and 4).

In addition to the above-mentioned 1) to 4) said vaccine compositionpreferably also comprises an adjuvant, which for example may be any ofthe adjuvants described herein below in the section “Adjuvant”.

Peptide fragments of TDO, which can be comprised in the vaccines of theinvention are for example described herein below in the sections“Immunogenically active peptide fragment of TDO” and “Polypeptidescomprising TDO or a fragment thereof”. Functional homologues, which maybe used in the vaccine compositions of the invention are describedherein below in the sections “Tryptophan 2,3-dioxygenase”;“Immunogenically active peptide fragment of TDO” and “Functionalhomologues” and “Polypeptides comprising TDO or a fragment thereof”.

Tryptophan 2,3-dioxygenase

Tryptophan 2,3-dioxygenase (TDO) is an enzyme involved in degradation ofL-trypto-phan to N-formylkynurenine. The catabolism of tryptophan causesa depletion of tryptophan which suppresses T-cell responses and promotesimmune tolerance in mammalian pregnancy, tumor resistance, chronicinfection, autoimmunity and allergic inflammation.

In particular, TDO may be an enzyme capable of catalyzing the followingreaction:

L-tryptophan+O₂=N-formyl-L-kynurenine

TDO according to the present invention may be any useful TDO. In generalit is preferred that the TDO is TDO of the same species which isintended to treat with the vaccine compositions of the invention. Inpreferred embodiments of the invention, the vaccine composition isintended for administration to a human being, and hence TDO may be humanTDO. The amino acid sequence of wild type human TDO is presented as SEQID NO:1 herein.

Thus, TDO may preferably be TDO of SEQ ID NO:1 or a functional homologuethereof sharing at least 70% sequence identity to TDO of SEQ ID NO: 1,and accordingly, functional homologuea preferably have at least 75%sequence identity, for example at least 80% sequence identity, such asat least 85% sequence identity, for example at least 90% sequenceidentity, such as at least 91% sequence identity, for example at least91% sequence identity, such as at least 92% sequence identity, forexample at least 93% sequence identity, such as at least 94% sequenceidentity, for example at least 95% sequence identity, such as at least96% sequence identity, for example at least 97% sequence identity, suchas at least 98% sequence identity, for example 99% sequence identitywith human TDO of SEQ ID NO:1.

Functional homologues of TDO and methods for determining sequenceidentity are described in more detail in the section “Functionalhomologues” herein below.

Since TDO potentially may have unwanted activity, then in one embodimentof the invention, the vaccine composition comprises mutant TDO, which isnot capable of catalyzing above-mentioned reaction, or which onlycatalyzing above-mentioned reaction with an activity at the most 10% ofthe TDO of SEQ ID NO:1. Such mutant TDO may in particular be TDO of SEQID NO:1 wherein one or more of the amino acids 144, 151, 328 and/or 342have been mutated to another amino acid or are deleted. In the contextof the present invention a “functional homologue” of TDO may be mutantTDO, which do not have the catalytic activity of wild type TDO, butwhich has the capability to induce an immune response to cellsexpressing TDO

Immunogenically Active Peptide Fragment of TDO

The wild-type human TDO i.e. the naturally occurring non-mutated versionof the protein is identified in SEQ ID NO: 1. The present inventioncovers vaccine compositions comprising TDO; immunologically activepeptide fragments of TDO; peptide fragments of TDO, wherein at the mosttwo amino acids have been substituted; and/or functional homologues ofTDO comprising a sequence identity of at least 70% to SEQ ID NO: 1. Theterm polypeptide fragment is used herein to define any non-full length(as compared to SEQ ID NO: 1) string of amino acid residues that aredirectly derived from or synthesized to be identical with SEQ ID NO:1.

A functional homologue can be defined as a full length or fragment ofTDO that differs in sequence from the wild-type TDO, such as wild-typehuman TDO, but is still capable of inducing an immune response againstTDO expressing cells such as cancer cells and DCs. The TDO expressed inthese cells may be wild type or endogenously mutated (such as acongenital mutant or a mutation induced during cell division or other).A functional homologue may be a mutated version or an alternative splicevariant of the wild-type TDO. In another aspect, functional homologuesof TDO are defined as described herein below. A functional homologue maybe, but is not limited to, a recombinant version of full length orfragmented TDO with one or more mutations and/or one or more sequencedeletions and/or additions introduced ex vivo.

Accordingly, in a specific embodiment the immunogenically active peptidefragment of the invention consists of at the most 400 amino acidresidues, such as of the most 300 amino acids residues, for example atthe most 200 amino acid residues, such as at the most 100 amino acidresidues, for example at the most 50 amino acid residues, for example atthe most 45 amino acid residues, such as at the most 40 amino acidresidues, for example at the most 35 amino acid residues, such as at themost 30 amino acid residues, for example at the most 25 amino acidresidues, such as 18 to 25 consecutive amino acids of TDO as identifiedin SEQ ID NO: 1 or a functional homologue thereof; the functionalhomologue being a polypeptide of identical sequence except that at themost three amino acids have been substituted, such as at the most twoamino acids have been substituted, such as at the most one amino acidhas been substituted. Said immunogenically active peptide fragment mayalso consists of at the most 400 amino acid residues, such as of themost 300 amino acids residues, for example at the most 200 amino acidresidues, such as at the most 100 amino acid residues, for example atthe most 50 amino acid residues, for example at the most 45 amino acidresidues, such as at the most 40 amino acid residues, for example at themost 35 amino acid residues, such as at the most 30 amino acid residues,for example at the most 25 amino acid residues, such as 18 to 25consecutive amino acids of TDO as identified in SEQ ID NO: 1, whereinone or more of the amino acids 144, 151, 328 and/or 342 have beenmutated to another amino acid or are deleted.

In one preferred embodiment of the invention, the immunogenically activepeptide fragment consists of in the range of 18 to 25 amino acids,preferably of 20 consecutive amino acids of TDO as identified in SEQ IDNO: 1 or a functional homologue thereof; the functional homologue beinga polypeptide of identical sequence except that at the most three aminoacids have been substituted, such as at the most two amino acids havebeen substituted, such as at the most one amino acid has beensubstituted.

Accordingly in another specific embodiment the immunogenically activepeptide fragment of the invention consists of the most 25 amino acidresidues, such as at the most 24 amino acid residues, such as at themost 23 amino acid residues, such as at the most 22 amino acid residues,such as at the most 21 amino acid residues, such as at the most 20 aminoacid residues, for example at the most 19 amino acid residues, such asat the most 18 amino acid residues, for example at the most 17 aminoacid residues, such as at the most 16 amino acid residues, for exampleat the most 15 amino acid residues, such as at the most 14 amino acidresidues, for example at the most 13 amino acid residues, such as at themost 12 amino acid residues, for example at the most 11 amino acidresidues, such as 8 to 10 consecutive amino acids from TDO of SEQ ID NO:1 or a functional homologue thereof; the functional homologue being apolypeptide of identical sequence except that at the most three aminoacids have been substituted, such as at the most two amino acids havebeen substituted, such as at the most one amino acid has beensubstituted.

In one preferred embodiment of the invention, the immunogenically activepeptide peptide comprises at the most 10 consecutive amino acid residuesfrom TDO, such as at the most 9 consecutive amino acid residues, such as8 consecutive amino acid residues, such as 7 consecutive amino acidresidues from TDO as identified in SEQ ID NO: 1 or a functionalhomologue thereof; the functional homologue being a polypeptide ofidentical sequence except that at the most three amino acids have beensubstituted, such as at the most two amino acids have been substituted,such as at the most one amino acid has been substituted. In particular,the immunogenically active peptide may consist of 10 consecutive aminoacid residues from TDO of SEQ ID NO:1 or the immunogenically activepeptide may consist of 9 consecutive amino acid residues from TDO of SEQID NO:1.

In some embodiments of the invention the immunogenically active peptidemay be selected from the group consisting of peptides listed in Table 1or a functional homologue thereof; the functional homologue being apolypeptide of identical sequence except that at the most three aminoacids have been substituted, such as at the most two amino acids havebeen substituted, such as at the most one amino acid has beensubstituted.

TABLE 1 Useful TDO peptides Amino acid numbers in SEQ ID SEQ ID NO NameNO: 1 Sequence SEQ ID NO: 2 TDO1 TDO₁₅₉₋₁₆₈ RLLENKIGVL SEQ ID NO: 3 TDO2TDO₂₀₀₋₂₀₈ TLLELVEAWL SEQ ID NO: 4 TDO3 TDO₇₂₋₈₁ FIITHQAYEL SEQ ID NO: 5TDO4 TDO₄₀₋₄₈ LIYGNYLHL SEQ ID NO: 6 TDO5 TDO₁₂₃₋₁₃₂ KLLVQQFSILSEQ ID NO: 7 TDO6 TDO₆₅₋₇₄ KIHDEHLFII SEQ ID NO: 8 TDO7 TDO₁₉₂₋₂₀₁LLKSEQEKTL SEQ ID NO: 9 TDO8 TDO₃₀₉₋₃₁₇ QLLTSLMDI SEQ ID NO: 10 TDO9TDO₈₅₋₉₃ QILWELDSV SEQ ID NO: 11 TDO10 TDO₁₃₀₋₁₃₈ SILETMTALSEQ ID NO: 12 TDO11 TDO₂₇₆₋₂₈₄ LLSKGERRL SEQ ID NO: 13 TDO12 TDO₃₆₄₋₃₇₂DLFNLSTYL SEQ ID NO: 14 TDO13 TDO₂₂₅₋₂₃₄ KLEKNITRGL SEQ ID NO: 15 TDO14TDO₃₇₂₋₃₈₁ LIPRHWIPKM SEQ ID NO: 16 TDO15 TDO₃₈₀₋₃₈₉ KMNPTIHKFLSEQ ID NO: 17 TDO₁₁₈₋₁₃₇ VSVILKLLVQQFSILE TMTA SEQ ID NO: 18 TDO₃₀₃₋₃₂₂RFQVPFQLLTSLMDID SLMT

In a preferred embodiment of the invention the immunogenically activepeptide is selected from the group consisting of:

a) SEQ ID NO:3 (TDO₂₀₀₋₂₀₈);

b) SEQ ID NO:6 (TDO₁₂₃₋₁₃₂);

c) SEQ ID NO:9 (TDO₃₀₉₋₃₁₇);

d) SEQ ID NO:13 (TDO₃₆₄₋₃₇₂);

e) SEQ ID NO:17 (TDO₁₁₈₋₁₃₇);

f) SEQ ID NO:18 (TDO₃₀₃₋₃₂₂); and

g) a functional homologue of the polypeptide according to any of a) tof); the functional homologue being a polypeptide of identical sequenceexcept that at the most three amino acids have been substituted, such asat the most two amino acids have been substituted, such as at the mostone amino acid has been substituted.

Other peptides of the invention comprise (or more preferably consist of)between 4 and 120, preferably between 8 and 100, more preferably between10 and 75, yet more preferably between 12 and 60, even more preferablybetween 15 and 40, such as between 18 and 25 contiguous amino acids ofTDO of SEQ ID NO: 1 or a functional homologue thereof having at least70%, preferably at least 80%, more preferably at least 90%, even morepreferably at least 95%, yet more preferably at least 98%, for exampleat least 99% sequence identity to SEQ ID NO: 1.

Functional Homologues

Functional homologues of TDO or immunogenically active fragmentsthereof, are polypeptides, which also are immunogenically active, andwhich shares at least some degree of sequence identity with TDO, and inparticular with TDO of SEQ ID NO:1.

For shorter polypeptides, such as for polypeptide shorter than 100 aminoacids, such as shorter than 50 amino acids, for example shorter than 25amino acids, then functional homologues may be an immunogenically activepolypeptide of identical sequence except that at the most three aminoacids have been substituted, such as at the most two amino acids havebeen substituted, such as at the most one amino acid has beensubstituted.

Alternatively, a functional homologue may be an immunogenically activepolypeptide sharing at least 70% sequence identity to TDO of SEQ ID NO:1, and accordingly, functional homologuea preferably have at least 75%sequence identity, for example at least 80% sequence identity, such asat least 85% sequence identity, for example at least 90% sequenceidentity, such as at least 91% sequence identity, for example at least91% sequence identity, such as at least 92% sequence identity, forexample at least 93% sequence identity, such as at least 94% sequenceidentity, for example at least 95% sequence identity, such as at least96% sequence identity, for example at least 97% sequence identity, suchas at least 98% sequence identity, for example 99% sequence identitywith human TDO of SEQ ID NO:1.

Sequence identity can be calculated using a number of well-knownalgorithms and applying a number of different gap penalties. Thesequence identity is calculated relative to full-length referencesequence, e.g. to full length SEQ ID NO: 1. Any sequence alignment tool,such as but not limited to FASTA, BLAST, or LALIGN may be used forsearching homologues and calculating sequence identity. Moreover, whenappropriate any commonly known substitution matrix, such as but notlimited to PAM, BLOSSUM or PSSM matrices may be applied with the searchalgorithm. For example, a PSSM (position specific scoring matrix) may beapplied via the PSI-BLAST program. Moreover, sequence alignments may beperformed using a range of penalties for gap opening and extension. Forexample, the BLAST algorithm may be used with a gap opening penalty inthe range 5-12, and a gap extension penalty in the range 1-2.

Functional homologues may further comprise chemical modifications suchas ubiquitination, labeling (e.g., with radionuclides, various enzymes,etc.), pegylation (derivatization with polyethylene glycol), or byinsertion (or substitution by chemical synthesis) of amino acids (aminoacids) such as ornithine, which do not normally occur in human proteins,however it is preferred that the functional equivalent does not containchemical modifications.

Any changes made to the sequence of amino acid residues compared to thatof TDO of SEQ ID NO: 1 are preferably conservative substitutions. Aperson skilled in the art will know how to make and assess‘conservative’ amino acid substitutions, by which one amino acid issubstituted for another with one or more shared chemical and/or physicalcharacteristics. Conservative amino acid substitutions are less likelyto affect the functionality of the protein. Amino acids may be groupedaccording to shared characteristics. A conservative amino acidsubstitution is a substitution of one amino acid within a predeterminedgroup of amino acids for another amino acid within the same group,wherein the amino acids within a predetermined groups exhibit similar orsubstantially similar characteristics.

Thus, in an embodiment of the present invention, the vaccine compositioncomprises a polypeptide consisting of a consecutive sequence of TDO ofSEQ ID NO: 1 in the range of 8 to 50 amino acids, preferably in therange of 8 to 10 or 20 to 25 amino acids, wherein at the most threeamino acid has been substituted, and where the substitution preferablyis conservative.

Polypeptides Comprising TDO or a Fragment Thereof

It is also comprised within the invention that the vaccine compositionsof the invention may comprise a polypeptide comprising either TDO or afragment thereof. Thus, the immunogenically active peptide fragment ofTDO may for example be any of the polypeptides comprising a TDO fragmentdescribed herein in this section.

In particular, such polypeptides may comprise full length TDO, such asany of the TDOs described herein above in the section “Tryptophan2,3-doxygenase”. For example the polypeptide may comprise TDO of SEQ IDNO:1 or a functional homologue thereof sharing at least 70%, such asatleast 80%, for example at least 90%, such as at least 95% sequenceidentity therewith. In particular, such polypeptides may comprise at themost 100, such as at the most 50, for example at the most 25, such as atthe most 10 amino acids in addition to TDO of SEQ ID NO:1.

It is also comprised within the invention that the vaccine compositionsmay comprise a polypeptide comprising a fragment of TDO, such as any ofthe fragments described herein above in the section “Immunogenicallyactive peptide fragment of TDO”. Said polypeptide may also comprise anyof the immunogenically active peptide fragments of TDO, which is an MHCClass I-restricted peptide fragment or MHC Class II-restricted peptidefragment, such as any of the an MHC Class I-restricted peptide fragmentsor MHC Class II-restricted peptide fragments described in the section“MHC”.

Thus, said polypeptide may be a polypeptide of at the most 400 aminoacids, such as at the most 300 amino acids, for example at the most 200amino acids, such as at the most 100 amino acids, for example at themost 50 amino acids comprising a consecutive sequence of amino acids ofSEQ ID NO:1, wherein said consecutive sequence of amino acids of SEQ IDNO:1 consists of at the most 50 amino acid residues, for example at themost 45 amino acid residues, such as at the most 40 amino acid residues,for example at the most 35 amino acid residues, such as at the most 30amino acid residues, for example at the most 25 amino acid residues,such as in the range of 18 to 25, such as in the range of 8 to 10consecutive amino acids from TDO of SEQ ID NO: 1 or a functionalhomologue thereof.

In particular, said polypeptide may be a polypeptide of at the most 100amino acids, such as at the most 80 amino acids, for example at the most60 amino acids, such as at the most 40 amino acids, for example at themost 30 amino acids comprising a consecutive sequence of amino acids ofSEQ ID NO:1, wherein said consecutive sequence of amino acids of SEQ IDNO:1 consists of in the range of 18 to 25, such as of 20 consecutiveamino acids from TDO of SEQ ID NO: 1 or a functional homologue thereof.Thus, said polypeptide may be a polypeptide of at the most 100 aminoacids, such as at the most 80 amino acids, for example at the most 60amino acids, such as at the most 40 amino acids, for example at the most30 amino acids comprising an immunogenically active peptide selectedfrom the group consisting of:

a) SEQ ID NO:3 (TDO₂₀₀₋₂₀₈);

b) SEQ ID NO:6 (TDO₁₂₃₋₁₃₂);

c) SEQ ID NO:9 (TDO₃₀₉₋₃₁₇);

d) SEQ ID NO:13 (TDO₃₆₄₋₃₇₂);

e) SEQ ID NO:17 (TDO₁₁₈₋₁₃₇);

f) SEQ ID NO:18 (TDO₃₀₃₋₃₂₂); and

g) a functional homologue of the polypeptide according to any of a) tof); the functional homologue being a polypeptide of identical sequenceexcept that at the most three amino acids have been substituted, such asat the most two amino acids have been substituted, such as at the mostone amino acid has been substituted.

In one embodiment, the immunogenically active peptide fragment of TDOmay be a polypeptide comprising or consisting a consecutive sequence ofat the most 400 amino acids, such as at the most 300 consecutive aminoacids, for example at the most 200 consecutive amino acids, such as atthe most 100 consecutive amino acids, for example at the most 50consecutive amino acids, for example at the most 45 consecutive aminoacid residues, such as at the most 40 consecutive amino acid residues,for example at the most 35 consecutive amino acid residues, such as atthe most 30 consecutive amino acid residues, for example at the most 25consecutive amino acid residues, such as in the range of 18 to 25, suchas in the range of 8 to 10 consecutive amino acids from TDO of SEQ IDNO: 1 or a functional homologue thereof where at the most three aminoacids have been substituted, such as at the most two amino acids havebeen substituted, such as at the most one amino acid has beensubstituted, and wherein said peptide fragment of TDO comprises at leastone sequence selected from the group consisting of:

a) SEQ ID NO:3 (TDO₂₀₀₋₂₀₈);

b) SEQ ID NO:6 (TDO₁₂₃₋₁₃₂);

c) SEQ ID NO:9 (TDO₃₀₉₋₃₁₇);

d) SEQ ID NO:13 (TDO₃₆₄₋₃₇₂);

e) SEQ ID NO:17 (TDO₁₁₈₋₁₃₇);

f) SEQ ID NO:18 (TDO₃₀₃₋₃₂₂);and

g) a functional homologue of the polypeptide according to any of a) tof); the functional homologue being a polypeptide of identical sequenceexcept that at the most three amino acids have been substituted, such asat the most two amino acids have been substituted, such as at the mostone amino acid has been substituted.

Said polypeptide may also be a polypeptide of at the most 100 aminoacids, such as at the most 50 amino acids, for example at the most 30amino acids, such as at the most 20 amino acids, for example at the most15 amino acids comprising a consecutive sequence of amino acids of SEQID NO:1, wherein said consecutive sequence of amino acids of SEQ ID NO:1consists of in the range of 8 to 10, such as of 9 or 10 consecutiveamino acids from TDO of SEQ ID NO: 1 or a functional homologue thereof.Thus, said polypeptide may be a polypeptide of at the most 100 aminoacids, such as at the most 50 amino acids, for example at the most 30amino acids, such as at the most 20 amino acids, for example at the most15 amino acids comprising an immunogenically active peptide selectedfrom the group consisting of:

a) SEQ ID NO:3 (TDO₂₀₀₋₂₀₈);

b) SEQ ID NO:6 (TDO₁₂₃₋₁₃₂);

c) SEQ ID NO:9 (TDO₃₀₉₋₃₁₇);

d) SEQ ID NO:13 (TDO₃₆₄₋₃₇₂); and

e) a functional homologue of the polypeptide according to any of a) tod); the functional homologue being a polypeptide of identical sequenceexcept that at the most three amino acids have been substituted, such asat the most two amino acids have been substituted, such as at the mostone amino acid has been substituted.

MHC

It is comprised within the invention that the immunogenially activepeptide fragments of TDO may be an MHC Class I-restricted peptidefragment or MHC Class II-restricted peptide fragment, such as any of thean MHC Class I-restricted peptide fragments or MHC Class II-restrictedpeptide fragments described in this section.

There are two types of MHC molecules; MHC class I molecules and MHCclass II molecules. MHC class I molecules are recognized by CD8 T-cells,which are the principal effector cells of the adaptive immune response.MHC class II molecules are mainly expressed on the surface of antigenpresenting cells (APCs), the most important of which appears to be thedendritic cells. APCs stimulate naïve T-cells, as well as other cells inthe immune system. They stimulate both CD8 T-cells and CD4 T-cells.

In one embodiment, the invention provides immunogenically active TDOpeptides (optionally comprised in larger peptides and/or in vaccinecompositions), wherein said immunogenically active TDO peptides are MHCClass I-restricted peptide fragments consisting of 8-10 consecutiveamino acids from TDO of SEQ ID NO 1 or a functional homologue thereof,wherein at the most two amino acids of SEQ ID NO 1 have beensubstituted, which are characterized by having at least one of severalfeatures, one of which is the ability to bind to the Class I HLAmolecule to which it is restricted at an affinity as measured by theamount of the peptide that is capable of half maximal recovery of theClass I HLA molecule (C₅₀ value) which is at the most 50 μM asdetermined by the assembly binding assay as described herein. Thisassembly assay is based on stabilization of the HLA molecule afterloading of peptide to the peptide transporter deficient cell line T2.Subsequently, correctly folded stable HLA heavy chains areimmunoprecipitated using conformation dependent antibodies and thepeptide binding is quantitated. The peptides of this embodimentcomprises (or more preferably consists of) at the most 200, preferablyat the most 100, more preferably at the most 50, yet more preferably atthe most 25, even more preferably at the most 20, yet even morepreferably at the most 15, such as at the most 10, for example in therange of 8 to 10 consecutive amino acids of TDO of SEQ ID NO 1or afunctional homologue thereof wherein at the most two amino acids of SEQID NO 1 have been substituted.

This assay provides a simple means of screening candidate peptides fortheir ability to bind to a given HLA allele molecule at the aboveaffinity. In preferred embodiments, the peptide fragment of theinvention in one having a C₅₀ value, which is at the most 30 μM, such asa C₅₀ value, which is at the most 20 μM including C₅₀ values of at themost 10 μM, at the most 5 μM and at the most 2 μM.

In another preferred embodiment, there are provided novel MHC ClassII-restricted peptide fragments of TDO of SEQ ID NO 1 or a functionalhomologue thereof, wherein at the most two amino acids of SEQ ID NO 1have been substituted, (also referred to herein as “peptides”), whichare characterized by having at least one of several features describedherein below. The peptides of this embodiment comprises (or morepreferably consists of) between 4 and 120, preferably between 8 and 100,more preferably between 10 and 75, yet more preferably between 12 and60, even more preferably between 15 and 40, such as between 18 and 25consecutive amino acids of TDO of SEQ ID NO 1 or a functional homologuethereof, wherein at the most two, preferably at the most one amino acidsof SEQ ID NO 1 have been substituted,

Thus there are provided novel MHC Class I-restricted peptide fragmentsof 8-10 amino acids or novel MHC Class II-restricted peptide fragmentsof 18-25 amino acids of TDO of SEQ ID NO 1 or a functional homologuethereof, wherein at the most two amino acids of SEQ ID NO 1 have beensubstituted, which are characterized by having at least one of severalfeatures described herein below, one of which is the ability to bind tothe Class I or Class II HLA molecule to which it is restricted.

In particular embodiments there are provided peptide fragments, which isan MHC Class I-restricted peptide or an MHC class II-restricted peptidehaving at least one of the following characteristics:

(i) capable of eliciting INF-γ-producing cells in a PBL population of atleast one cancer patient at a frequency of at least 1 per 10⁴ PBLs asdetermined by an ELISPOT assay, and/or

(ii) capable of in situ detection in a tumor tissue of CTLs that arereactive with the epitope peptide.

(iii) capable of inducing the growth of TDO specific T-cells in vitro.

More preferred peptides according to the present invention are peptidescapable of raising a specific T-cell response as determined by anELISPOT assay, for example the ELISPOT assay described in Example 1herein below. Some peptides although they do not bind MHC class I orclass II with high affinity, may still give rise to a T-cell response asdetermined by ELISPOT. Other peptides capable of binding MHC class I orclass II with high affinity also give rise to a T-cell response asdetermined by ELISPOT. Both kinds of peptides are preferred peptidesaccording to the invention.

Hence, preferred peptides according to the present invention arepeptides capable of raising a specific T-cell response as measured by anELISPOT assay, wherein more than 50 peptide specific spots per 10⁸cells, more preferably per 10⁷, even more preferably per 10⁶, yet morepreferably per 10⁵ cells, such as per 10⁴ cells are measured.

Most preferred peptides according to the present invention are peptidesthat are capable of eliciting a cellular immune response in anindividual suffering from a clinical condition characterized by theexpression of TDO, the clinical condition preferably being a cancer orinfection, and most preferably a cancer.

Preferred peptides according to the present invention are capable ofeliciting a specific cellular immune response directed against cellsexpressing TDO. Thus, the peptides preferably can activate TDO specificT-cells recognizing cells expressing TDO.

As described above, the HLA system represents the human majorhistocompatibility (MHC) system. Generally, MHC systems control a rangeof characteristics: transplantation antigens, thymus dependent immuneresponses, certain complement factors and predisposition for certaindiseases. More specifically, the MHC codes for three different types ofmolecules, i.e. Class I, II and III molecules, which determine the moregeneral characteristics of the MHC. Of these molecules, the Class Imolecules are so-called HLA-A, HLA-B and HLA-C molecules that arepresented on the surface of most nucleated cells and thrombocytes.

The peptides of the present invention are characterized by their abilityto bind to (being restricted by) a particular MHC Class I HLA molecule.Thus, in one embodiment the peptide is one which is restricted by a MHCClass I HLA-A molecule including HLA-A1, HLA-A2, HLA-A3, HLA-A9,HLA-A10, HLA-A11, HLA-Aw19, HLA-A23(9), HLA-A24(9), HLA-A25(10),HLA-A26(10), HLA-A28, HLA-A29(w19), HLA-A30(w19), HLA-A31(w19),HLA-A32(w19), HLA-Aw33(w19), HLA-Aw34(10), HLA-Aw36, HLA-Aw43,HLA-Aw66(10), HLA-Aw68(28), HLA-A69(28). More simple designations arealso used throughout the literature, where only the primary numericdesignation is used, e.g. HLA-A19 or HLA-A24 instead of HLA-Aw19 andHLA-A24(49), respectively. In specific embodiments, the peptide of theinvention is restricted a MHC Class I HLA species selected from thegroup consisting of HLA-A1, HLA-A2, HLA-A3, HLA-A11 and HLA-A24. Inspecific embodiment, the peptide of the invention is restricted a MHCClass I HLA species HLA-A2 or HLA-A3.

In further useful embodiments, the peptide of the invention is apeptide, which is restricted by a MHC Class I HLA-B molecule includingany of the following: HLA-B5, HLA-B7, HLA-B8, HLA-B12, HLA-B13, HLA-B14,HLA-B15, HLA-B16, HLA-B17, HLA-B18, HLA-B21, HLA-Bw22, HLA-B27, HLA-B35,HLA-B37, HLA-B38, HLA-B39, HLA-B40, HLA-Bw41, HLA-Bw42, HLA-B44,HLA-B45, HLA-Bw46 and HLA-Bw47. In specific embodiments of theinvention, the MHC Class I HLA-B species to which the peptide of theinvention is capable of binding is selected from HLA-B7, HLA-B35,HLA-B44, HLA-B8, HLA-B15, HLA-B27 and HLA-B51.

In further useful embodiments, the peptide of the invention is apeptide, which is restricted by a MHC Class I HLA-C molecule includingbut not limited to any of the following: HLA-Cw1, HLA-Cw2, HLA-Cw3,HLA-Cw4, HLA-Cw5, HLA-Cw6, HLA-Cw7 and HLA-Cw1.

In further useful embodiments, the peptide of the invention is apeptide, which is restricted by a MHC Class II HLA molecule includingbut not limited to any of the following: HLA-DPA-1, HLA-DPB-1, HLA-DQA1,HLA-DQB1, HLA-DRA, HLA-DRB and all alleles in these groups and HLA-DM,HLA-DO.

The selection of peptides potentially having the ability to bind to aparticular HLA molecule can be made by the alignment of known sequencesthat bind to a given particular HLA molecule to thereby reveal thepredominance of a few related amino acids at particular positions in thepeptides. Such predominant amino acid residues are also referred toherein as “anchor residues” or “anchor residue motifs”. By followingsuch a relatively simple procedure based on known sequence data that canbe found in accessible databases, peptides can be derived from TDO,which are likely to bind to a specific HLA molecule. Representativeexamples of such analyses for a range of HLA molecules are given in thebelow table:

TABLE 2 C- HLA allele Position 1 Position 2 Position 3 Position 5Position 6 Position 7 terminal HLA-A1 T, S D, E L Y HLA-A2 L, M V L, VHLA-A3 L, V, M F, Y K, Y, F HLA-A11 V, I, F, Y M, L, F, Y, I K, RHLA-A23 I, Y W, I HLA-A24 Y I, V F I, L, F HLA-A25 M, A, T I W HLA-A26E, D V, T, I, L, F I, L, V Y, F HLA-A28 E, D V, A, L A, R HLA-A29 E Y, LHLA-A30 Y, L, F, V Y HLA-A31 L, M, F, Y R HLA-A32 I, L W HLA-A33 Y, I,L, V R HLA-A34 V, L R HLA-A66 E, D T, V R, K HLA-A68 E, D T, V R, KHLA-A69 V, T, A V, L HLA-A74 T V, L HLA-B5 A, P F, Y I, L HLA-B7 * P L,F HLA-B8 K K, R L HLA-B14 R, K L, V HLA-B15 Q, L, K, P, F, Y, W (B62) H,V, I, M, S, T HLA-B17 L, V HLA-B27 R Y, K, F, L HLA-B35 P I, L, M, YHLA-B37 D, E I, L, M HLA-B38 H D, E F, L HLA-B39 R, H L, F HLA-B40 E F,I, V L, V, A, W, (B60, 61) M, T, R HLA-B42 L, P Y, L HLA-B44 E F, Y, WHLA-B46 M, I, L, V Y, F HLA-B48 Q, K L HLA-B51 A, P, G F, Y, I, VHLA-B52 Q F, Y I, V HLA-B53 P W, F, L HLA-B54 P HLA-B55 P A, V HLA-B56 PA, V HLA-B57 A, T, S F, W, Y HLA-B58 A, T, S F, W, Y HLA-B67 P L HLA-B73R P HLA-Cw1 A, L L HLA-Cw2 A, L F, Y HLA-Cw3 A, L L, M HLA-Cw4 Y, P, FL, M, F, Y HLA-Cw6 L, I, V, Y HLA-Cw6 Y L, Y, F HLA-Cw8 Y L, I, HLA-Cw16A, L L, V *In one embodiment there is no specific anchor residue forthis position, however in a preferred embodiment the anchor residue is Ror A.

Thus, as an example, nonapeptides potentially having the ability to bindto HLA-A3 would have one of the following sequences:Xaa-L-Y-Xaa-Xaa-Xaa-Xaa-Xaa-K, Xaa-L-Y-Xaa-Xaa-Xaa-Xaa-Xaa-Y;Xaa-L-Y-Xaa-Xaa-Xaa-Xaa-Xaa-F or Xaa-V-Y-Xaa-Xaa-Xaa-Xaa-Xaa-K (Xaaindicating any amino acid residue). In a similar manner, sequencespotentially having the ability to bind to any other HLA molecule can bedesigned. It will be appreciated that the person of ordinary skill inthe art will be able to identify further “anchor residue motifs” for agiven HLA molecule.

The peptide of the invention may have a sequence which is a nativesequence of the TDO from which is derived. However, peptides having ahigher affinity to any given HLA molecule may be derived from such anative sequence by modifying the sequence by substituting, deleting oradding at least one amino acid residue, e.g. on the basis of theprocedure described above, whereby anchor residue motifs in respect ofthe given HLA molecule are identified.

Thus, in useful embodiments, the polypeptides of the invention includepeptides, the sequences of which comprise, for each of the specific HLAalleles listed in the table, any of the amino acid residues as indicatedin the table.

Thus, the peptides of the invention may be any of the above-mentionedpeptides comprising consecutive sequences from TDO, wherein in the rangeof 1 to 10, preferably in the range of 1 to 5, more preferably in therange of 1 to 3, even more preferably in the range of 1 to 2, yet morepreferably 1 amino acid has been exchanged for another amino acid,preferably in a manner so that the peptide comprises one or more,preferably all anchor residues of a given HLA-A specific peptide asindicated in the table above.

Examples preferable HLA species include, to which preferred peptides ofthe present invention are restricted include: a MHC Class I HLA speciesselected from the group consisting of HLA-A1, HLA-A2, HLA-A3, HLA-A11and HLA-A24, more preferably the peptide is restricted by HLA-A3 orHLA-A2. Alternatively a preferred HLA species includes MHC Class I HLA-Bspecies selected from the group consisting of HLA-B7, HLA -B35, HLA-B44, HLA-B8, HLA-B15, HLA-B27 and HLA-B51.

An approach to identifying polypeptides of the invention includes thefollowing steps: selecting a particular HLA molecule, e.g. one occurringat a high rate in a given population, carrying out an alignment analysisas described above to identify “anchor residue motifs” in the TDOprotein, isolating or constructing peptides of a suitable size thatcomprise one or more of the identified anchor residues and testing theresulting peptides for the capability of the peptides to elicitINF-γ-producing cells in a PBL population of a cancer patient at afrequency of at least 1 per 10⁴ PBLs as determined by an ELISPOT assayas described in Example 1.

In one aspect of the present invention, TDO-derived peptides longer than8 to 10 amino acid residues are provided. Polypeptides longer than 8 to10 amino acids are processed by the proteasome to a shorter length forbinding to HLA molecules. Thus, when administering a polypeptide longerthan 8 to 10 amino acid residues long, the “long”polypeptide/protein/protein fragment/variant of TDO may be processed invivo into a series of smaller peptides in the cytosol by the proteasome.An advantage of using a longer polypeptide that may be processed by theproteasome into a variety of different shorter peptides is that more HLAclasses may be targeted with one peptide than one 8 to 10 amino acidpeptide that is restricted to a particular HLA class.

Surprisingly, some of the peptides of the present invention bind to MHCmolecules with an affinity sufficiently high to render substitutionsunnecessary and are ready for use as antigens as they are presentedhere. Preferably, the vaccine composition of the present inventioncomprises one or more of the following: TDO protein (SEQ ID NO: 1),polypeptide fragments here from, likewise variants, functionalhomologues of full length and partial length TDO, contiguous peptides ofTDO and functional homologues of these. More preferably, the vaccinecomposition comprises any of the sequences listed in Table 1. Verypreferably, the vaccine composition comprises the peptides SEQ ID NO:3(TDO₂₀₀₋₂₀₈);SEQ ID NO:6 (TDO₁₂₃₋₁₃₂);SEQ ID NO:9 (TDO₃₀₉₋₃₁₇);SEQ IDNO:13 (TDO₃₆₄₋₃₇₂);SEQ ID NO:17 (TDO₁₁₈₋₁₃₇); and/or SEQ ID NO:18(TDO₃₀₃₋₃₂₂).

A significant feature of the peptide of the invention is its capabilityto recognize or elicit INF-γ-producing responder T cells, i.e. cytotoxicT cells (CTLs) that specifically recognize the particular peptide in aPBL population, on an APC or tumor/neoplastic cells of an individualsuffering from a cancer and/or an infection (target cells). Thisactivity is readily determined by subjecting PBLs, APCs or tumor cellsfrom an individual to an ELISPOT assay. Prior to the assay, it may beadvantageous to stimulate the cells to be assayed by contacting thecells with the peptide to be tested. Preferably, the peptide is capableof eliciting or recognizing INF-γ-producing T cells at a frequency of atleast 1 per 10⁴ PBLs as determined by an ELISPOT assay as used herein.More preferably the frequency is at least 5 per 10⁴ PBLs, mostpreferably at least 10 per 10⁴ PBLs, such as at least 50 or 100 per 10⁴PBLs.

The ELISPOT assay represents a strong tool to monitor TDO peptidespecific T-cell responses. A major implication of the findings herein isthat the peptides of the invention are expressed and complexed with HLAmolecules on cancer cells and/or TDO expressing APCs. This renders thesecancer cells susceptible to destruction by CTLs and emphasizes theusefulness of TDO immunization to fight cancer and infections. Thepresence of spontaneous CTL-responses in PBLs from melanoma patients toHLA-restricted TDO derived peptide epitopes shows the immunotherapeuticpotential of TDO immunogenic peptides.

In an embodiment of the present invention the peptide of the inventionis capable of eliciting INF-γ-producing cells in a PBL population of anindividual suffering from an clinical condition where TDO of SEQ ID NO:1or a functional homologue thereof having at least 70% identity to SEQ IDNO 1 is expressed. The clinical condition is preferably a cancer or andinfection and most preferably a cancer.

Individual

The individual to be treated with the vaccine composition of the presentinvention is an individual suffering from a clinical condition. Theindividual is preferably of a mammalian species and most preferably ahuman being. The individual may be of any age, young or old, and may beeither male or female. The clinical condition from which the individualsuffers may be a neoplastic disease such as a cancer, or an infectionsuch as a microbial or viral infection e.g. HIV.

An embodiment of the present invention provides a vaccine for thetreatment, reduction of risk of, stabilization of or prevention of acancer. In another embodiment the present invention provides a vaccinefor the treatment, reduction of risk of, stabilization of or preventionof a disease stemming from an infection, such as a microbial or viralinfection.

Cancer

The vaccine composition of the present invention may be used to prevent,reduce the risk of or treat a clinical condition. Preferably, theclinical condition is associated with or characterized by the expressionof TDO. TDO may be TDO as identified in SEQ ID NOs: 1 or may be ahomolog sharing at least 70% identity with any of these in their wildtype forms, but need not be functional. It is understood hereby that theexpression level of TDO (the expression being expression of hnRNA, mRNA,precursor protein, fully processed protein and so on) is the same orhigher than in an individual not suffering from a clinical condition.

The one embodiment of the invention the clinical condition is aproliferative disorder, such as a preneoplastic or neoplastic disorder.In a preferred embodiment of the invention, the clinical condition iscancer. Cancer (malignant neoplasm) is a class of diseases in which agroup of cells display the traits of uncontrolled growth (growth anddivision beyond the normal limits), invasion (intrusion on anddestruction of adjacent tissues), and sometimes metastasis (spread toother locations in the body via lymph or blood). These three malignantproperties of cancers differentiate them from benign tumors, which areself-limited, do not invade or metastasize. Most cancers form a tumorbut some, like leukemia, do not.

A non-limiting group of cancers given as examples of cancers that may betreated, managed and/or prevented by administration of the vaccine ofthe present invention include: colon carcinoma, breast cancer,pancreatic cancer, ovarian cancer, prostate cancer, fibrosarcoma,myxosarcoma, liposarcoma, chondrosarcoma, osteogenic sarcoma, chordoma,angiosarcoma, endotheliosarcoma, lymphangeosarcoma, lymphangeoendotheliasarcoma, synovioma, mesothelioma, Ewing's sarcoma, leiomyosarcoma,rhabdomyosarcoma, squamous cell carcinoma, basal cell carcinoma,adenocarcinoma, sweat gland carcinoma, sebaceous gland carcinoma,papillary carcinoma, papillary adenocarcinomas, cystandeocarcinoma,medullary carcinoma, bronchogenic carcinoma, renal cell carcinoma,hepatoma, bile duct carcinoma, choriocarcinoma, seminoma, embryonalcarcinoma, Wilms' tumor, cervical cancer, testicular tumor, lungcarcinoma, small cell lung carcinoma, bladder carcinoma, epithelialcarcinoma, glioblastomas, neuronomas, craniopharingiomas, schwannomas,glioma, astrocytoma, medulloblastoma, craniopharyngioma, ependymoma,pinealoma, hemangioblastoma, acoustic neuroama, oligodendroglioma,meningioma, melanoma, neuroblastoma, retinoblastoma, leukemias andlymphomas, acute lymphocytic leukemia and acute myelocytic polycythemiavera, multiple myeloma, Waldenstrom's macroglobulinemia, and heavy chaindisease, acute nonlymphocytic leukemias, chronic lymphocytic leukemia,chronic myelogenous leukemia, Hodgkin's Disease, non-Hodgkin'slymphomas, rectum cancer, urinary cancers, uterine cancers, oralcancers, skin cancers, stomach cancer, brain tumors, liver cancer,laryngeal cancer, esophageal cancer, mammary tumors, childhood-nullacute lymphoid leukemia (ALL), thymic ALL, B-cell ALL, acute myeloidleukemia, myelomonocytoid leukemia, acute mega-karyocytoid leukemia,Burkitt's lymphoma, acute myeloid leukemia, chronic myeloid leukemia,and T cell leukemia, small and large non-small cell lung carcinoma,acute granulocytic leukemia, germ cell tumors, endometrial cancer,gastric cancer, cancer of the head and neck, chronic lymphoid leukemia,hairy cell leukemia and thyroid cancer.

In a preferred embodiment the vaccine composition according to theinvention is capable of eliciting a clinical response in subject,wherein the clinical response may be characterized by a stable disease,in a preferred embodiment the clinical response may be characterized bya partial response or preferably the clinical response may becharacterized by complete remission of a cancer. Preferably, the canceris selected from the group of; melanoma, breast cancer, ovarian cancer,lung cancer, pancreatic cancer, hematologic cancers (such as leukemias),colon and renal cell cancers.

In one aspect of the invention the vaccine composition is capable ofeliciting a clinical response in an individual. In one embodiment theclinical response may be characterized by a stable disease (no furtherworsening or progression), in a preferred embodiment the clinicalresponse may be characterized by a partial response or preferably theclinical response may be characterized by complete remission of a canceror infections. The clinical response may be determined as describedherein below.

In another aspect of the invention the vaccine composition is capable ofeliciting a clinical response in subject, wherein the clinical responseis characterized by a decrease in the sum of the longest diameter of thelargest target lesion. The decrease may be determined as describedherein below.

All measurable lesions up to a maximum of five lesions per organ and 10lesions in total, representative of all involved organs should beidentified as target lesions and recorded and measured at baseline.

-   -   Target lesions should be selected on the basis of their size        (lesions with the longest diameter) and their suitability for        accurate repeated measurements (either by imaging techniques or        clinically).    -   A sum of the longest diameter (LD) for all target lesions will        be calculated and reported as the baseline sum LD. The baseline        sum LD will be used as reference by which to characterize the        objective tumor.    -   All other lesions (or sites of disease) should be identified as        non-target lesions and should also be recorded at baseline.        Measurements of these lesions are not required, but the presence        or absence of each should be noted throughout follow-up.

Evaluation of Target Lesions

-   -   Complete Response (CR): Disappearance of all target lesions    -   Partial Response (PR): At least a 30% decrease in the sum of the        LD of target lesions, taking as reference the baseline sum LD    -   Progressive Disease (PD): At least a 20% increase in the sum of        the LD of target lesions, taking as reference the smallest sum        LD recorded since the treatment started or the appearance of one        or more new lesions    -   Stable Disease (SD): Neither sufficient shrinkage to qualify for        PR nor sufficient increase to qualify for PD, taking as        reference the smallest sum LD since the treatment started

Evaluation of Non-Target Lesions

-   -   Complete Response (CR): Disappearance of all non-target lesions        and normalization of tumor marker level    -   Incomplete Response/Stable Disease (SD): Persistence of one or        more non-target lesion(s) or/and maintenance of tumor marker        level above the normal limits    -   Progressive Disease (PD): Appearance of one or more new lesions        and/or unequivocal progression of existing non-target lesions

In an embodiment of the present invention the vaccine compositioncomprising any of the herein mentioned proteins and/or polypeptides iscapable of eliciting a clinical response in a subject, wherein theclinical response is characterized by a decrease in the sum of thelongest diameter of the largest target lesion

It is contemplated that the vaccine composition of the invention iscapable of eliciting an immune response against a cancer expressing TDOof SEQ ID NO: 1 or a functional homologue thereof having at least 70%identity to SEQ ID NO: 1, when administered to an individual sufferingfrom a cancer expressing TDO. The vaccine composition of the inventionis capable of eliciting the production in a vaccinated individual ofeffector T-cells having a cytotoxic effect against the cancer cells, TDOexpressing APCs and/or inducing infiltration of antigen specific T-cellsin tumor stroma in a subject.

In addition to their capacity to elicit immune responses in PBLpopulations it is also contemplated that the peptides of the inventionare capable of eliciting cytolytic immune responses in situ, i.e. insolid tumor tissues. This may for example be demonstrated by providingHLA-peptide complexes, e.g. being multimerized and being provided with adetectable label, and using such complexes for immunohistochemistrystainings to detect in a tumor tissue CTLs that are reactive with theepitope peptide of the invention. Accordingly, a further significantfeature of the peptide of the invention is that it is capable of in situdetection in a tumor tissue of CTLs that are reactive with the epitopepeptide.

It is also contemplated that the peptides of the invention, in additionto their capacity to bind to HLA molecules resulting in the presentationof complexes of HLA and peptides on cell surfaces, which complexes inturn act as epitopes or targets for cytolytic T cells, may elicit othertypes of immune responses, such as B-cell responses resulting in theproduction of antibodies against the complexes and/or a Delayed TypeHypersensitivity (DTH) reaction. The latter type of immune response isdefined as a redness and palpable induration at the site of injection ofthe peptide of the invention.

It is an object of the presenting invention to provide a vaccinecomposition comprising Tryptophan 2,3-dioxygenase (TDO) of SEQ ID NO: 1or a functional homologue thereof having at least 70% identity to SEQ IDNO: 1 or an immunogenically active peptide fragment comprising aconsecutive sequence of said TDO or said functional homologue thereof ora nucleic acid encoding said TDO or said peptide fragment; and anadjuvant, for the prevention of, reduction of risk from or treatment ofcancer.

Cancer Combination Treatment

In some cases it will be appropriate to combine the treatment method ofthe invention with a further cancer treatment such as chemotherapy,radiotherapy, treatment with immunostimulating substances, gene therapy,treatment with antibodies and treatment using dendritic cells.

Since elevated expression of TDO in tumor cells leads to inhibition ofthe immune system, the combination of a TDO-based immunotherapy asdisclosed by the present invention with cytotoxic chemotherapy and oranother anti-cancer immunotherapeutic treatment is an effective approachto treat cancer. These remedies are also referred to herein as “secondactive ingredients”.

Examples of chemotherapeutic agents that are of relevance in regards toco-administration (sequentially or simultaneously) with the vaccinecomposition of the present invention include, but are not limited to:all-trans retinoic acid, Actimide, Azacitidine, Azathioprine, Bleomycin,Carboplatin, Capecitabine, Cisplatin, Chlorambucil, Cyclophosphamide,Cytarabine, Daunorubicin, Docetaxel, Doxifluridine, Doxorubicin,Epirubicin, Etoposide, Fludarabine, Fluorouracil, Gemcitabine,Hydroxyurea, Idarubicin, Irinotecan, Lenalidomide, Leucovorin,Mechlorethamine, Melphalan, Mercaptopurine, Methotrexate, Mitoxantrone,Oxaliplatin, Paclitaxel, Pemetrexed, Revlimid, Temozolomide, Teniposide,Thioguanine, Valrubicin, Vinblastine, Vincristine, Vindesine andVinorelbine. In one embodiment, a chemotherapeutic agent for use in thecombination of the present agent may, itself, be a combination ofdifferent chemotherapeutic agents. Suitable combinations include FOLFOXand IFL. FOLFOX is a combination which includes 5-fluorouracil (5-FU),leucovorin, and oxaliplatin. IFL treatment includes irinotecan, 5-FU,and leucovorin.

Another second active ingredient may be a kinase inhibitor, forseparate, simultaneous or combined use in the treatment of tumors.Suitable kinase inhibitors include those which have been shown topossess anti-tumor activity (such as gefitinib (Iressa) and erlotinib(Tarceva) and these could be used in combination with the peptides. Thereceptor tyrosine kinase inhibitors, such as Sunitinib malate andSorafenib which have been shown to be effective in the treatment ofrenal cell carcinoma are also suitable to be used as second activeingredients.

Further examples of second active ingredients are immunostimulatingsubstances e.g. cytokines and antibodies. Such as cytokines may beselected from the group consisting of, but not limited to: GM-CSF, typeI IFN, interleukin 21, interleukin 2, interleukin 12 and interleukin 15.The antibody is preferably an immunostimulating antibody such asanti-CD40 or anti-CTLA-4 antibodies. The immunostimulatory substance mayalso be a substance capable of depletion of immune inhibitory cells(e.g. regulatory T-cells) or factors, said substance may for example beE3 ubiquitin ligases. E3 ubiquitin ligases (the HECT, RING and U-boxproteins) have emerged as key molecular regulators of immune cellfunction, and each may be involved in the regulation of immune responsesduring infection by targeting specific inhibitory molecules forproteolytic destruction. Several HECT and RING E3 proteins have now alsobeen linked to the induction and maintenance of immune self-tolerance:c-Cbl, Cbl-b, GRAIL, Itch and Nedd4 each negatively regulate T cellgrowth factor production and proliferation.

In an embodiment, the vaccine composition of the present invention,comprising an TDO derived polypeptide, is administered in combinationwith a second active ingredient, such as an immunostimulatory substance.The immunostimulatory substance is preferably an interleukin such asIL-21 or IL-2 or a chemotherapeutic agent.

The vaccine compositions of the invention may also comprise one or moreadditional antigens in addition to TDO. Said antigens, may for examplebe immunogenically active peptides derived from cancer associatedproteins.

Thus, the vaccine compositions of the invention may in addition to TDOand/or immunogenically active peptide fragments thereof also compriseone or more of the following:

-   -   1) IDO    -   2) An immunogenically active peptide fragment of IDO    -   3) A functional homologue of 1) or 2)    -   4) A polypeptide comprising 1) , 2) or 3)    -   5) A nucleic acid encoding any of 1), 2), 3) or 4).

Said IDO may in particular be IDO of SEQ ID NO:1 of WO 2009/143843, IDOof SEQ ID NO:13 of WO 2009/143843, IDO of SEQ ID NO:14 of WO2009/143843, IDO of SEQ ID NO:15 of WO 2009/143843 or IDO of SEQ IDNO:16 of WO 2009/143843. Useful immunogenically active peptide fragmentsof IDO, which can be contained in the vaccine compositions of thepresent invention are described in WO 2009/143843.

The vaccine compositions of the invention may in addition to TDO and/orimmunogenically active peptide fragments thereof also comprise one ormore of the following:

-   -   1) PD-L1    -   2) An immunogenically active peptide fragment of PD-L1    -   3) A functional homologue of 1) or 2)    -   4) A polypeptide comprising 1) , 2) or 3)    -   5) A nucleic acid encoding any of 1), 2), 3) or 4).

Said PD-L1 may in particular be PD-L1 of SEQ ID NO:1 of WO2013/056716.Useful immunogenically active peptide fragments of PD-L1, which can becontained in the vaccine compositions of the present invention aredescribed in WO2013/056716.

Infections

In another embodiment of the invention, the vaccine compositionsdisclosed herein are for treatment or prevention of an inflammatorycondition.

The term “inflammatory condition” as used herein relates to any kind ofclinical condition giving rise to an immune response, such as aninflammation, and therefore includes infectious diseases, chronicinfections, autoimmune conditions and allergic inflammations. Thus,inflammatory conditions, such as infectious diseases, chronicinfections, autoimmune conditions and allergic inflammations are allclinical conditions of relevance for the present invention, and aredealt with in turn hereunder.

Inflammation is the complex biological response of vascular tissues toharmful stimuli, such as pathogens, damaged cells, or irritants. It is aprotective attempt by the organism to remove the injurious stimuli aswell as initiate the healing process for the tissue. Inflammation can beclassified as either acute or chronic. Acute inflammation is the initialresponse of the body to harmful stimuli and is achieved by the increasedmovement of plasma and leukocytes from the blood into the injuredtissues. A cascade of biochemical events propagates and matures theinflammatory response, involving the local vascular system, the immunesystem, and various cells within the injured tissue. Prolongedinflammation, known as chronic inflammation, leads to a progressiveshift in the type of cells which are present at the site of inflammationand is characterized by simultaneous destruction and healing of thetissue from the inflammatory process. In either case, TDO is expressedby cells of the immune system such as the APCs and therefore infectionsand inflammations are clinical conditions that may be treated,prevented, or from which the risk may be reduced by the administrationof the vaccine composition of the present invention. The vaccinecomposition preferably comprises TDO protein, protein fragments,polypeptide or peptides derived there from or functional homologues ofany of these.

Examples of disorders associated with inflammation which are ofrelevance to the presenting invention include, but are not limited to:Allergic inflammations, Asthma, Autoimmune diseases, Chronicinflammations, Chronic prostatitis, Glomerulonephritis,Hypersensitivities, Infectious diseases, Inflammatory bowel diseases,Pelvic inflammatory disease, Reperfusion injury, Rheumatoid arthritis,Transplant rejection, and Vasculitis.

Chronic Inflammations

Chronic inflammation is especially of relevance in regards to thepresent invention. A chronic inflammation is a pathological conditioncharacterized by concurrent active inflammation, tissue destruction, andattempts at repair. Chronically inflamed tissue is characterized by theinfiltration of mononuclear immune cells (monocytes, macrophages,lymphocytes, and plasma cells), tissue destruction, and attempts athealing, which include angiogenesis and fibrosis.

In acute inflammation, removal of the stimulus halts the recruitment ofmonocytes (which become macrophages under appropriate activation) intothe inflamed tissue, and existing macrophages exit the tissue vialymphatics. However in chronically inflamed tissue the stimulus ispersistent, and therefore recruitment of monocytes is maintained,existing macrophages are tethered in place, and proliferation ofmacrophages is stimulated (especially in atheromatous plaques).

It is an object of the presenting invention to provide a vaccinecomposition comprising Tryptophan 2,3-dioxygenase (TDO) of SEQ ID NO: 1or a functional homologue thereof having at least 70% identity to SEQ IDNO: 1 or an immunogenically active peptide fragment comprising aconsecutive sequence of said TDO or said functional homologue thereof ora nucleic acid encoding said TDO or said peptide fragment; and anadjuvant, for the prevention of, reduction of risk from or treatment ofchronic inflammations.

Infectious Diseases

The vaccine composition of the present invention may be used to prevent,reduce the risk from or treat a clinical condition. In a preferredembodiment of the invention, the clinical condition is an infectiousdisease. The infectious disease may be promoted by any infectious agentsuch as bacteria, virus, parasites and or fungi that are capable ofinducing an increased expression of TDO in the individual suffering fromthe infectious disease, preferably, the infectious disease is or is atrisk of becoming a chronic disease. As described in the background ofinvention, the increased expression of TDO has an immediate effect onthe microbial agents in the vicinity of the TDO expressing organism bydepriving it of tryptophan. However, this approach backfires, as theincreased TDO expression induces inhibits the activity of Treg cells, ifthe TDO expressing cell is an APC. Therefore it is an aspect of thepresent invention to provide a vaccine composition comprising TDOprotein, protein fragments, peptides and or variant of any of these forthe treatment, amelioration of (lessening of severity) stabilizationand/or prevention of a disease caused by an infectious agent.

An infectious diseases may be caused by a virus, and viral diseasesagainst which the vaccine composition of the present invention may beadministered in the treatment of include, but are not limited to thefollowing viral diseases: HIV, AIDS, AIDS Related Complex, Chickenpox(Varicella), Common cold, Cytomegalovirus Infection, Colorado tickfever, Dengue fever, Ebola hemorrhagic fever, Hand, foot and mouthdisease, Hepatitis, Herpes simplex, Herpes zoster, HPV (Humanpapillomavirus), Influenza (Flu), Lassa fever, Measles, Marburghemorrhagic fever, Infectious mononucleosis, Mumps, Norovirus,Poliomyelitis, Progressive multifocal leukencephalopathy, Rabies,Rubella, SARS, Smallpox (Variola), Viral encephalitis, Viralgastroenteritis, Viral meningitis, Viral pneumonia, West Nile disease,and Yellow fever. Preferably, the vaccine composition is administered toindividuals suffering from HIV/AIDS and viral infections that may causecancer. The main viruses associated with human cancers are humanpapillomavirus, hepatitis B and hepatitis C virus, Epstein-Barr virus,and human T-lymphotropic virus; thus it is an object of the presentinvention to be administered as the treatment of or as part of thetreatment of these viral infections.

Examples of bacterial infections of relevance for the present inventioninclude, but are not limited to: Anthrax, Bacterial Meningitis,Botulism, Brucellosis, Campylobacteriosis, Cat Scratch Disease, Cholera,Diphtheria, Epidemic Typhus, Gonorrhea, Impetigo, Legionellosis, Leprosy(Hansen's Disease), Leptospirosis, Listeriosis, Lyme disease,Melioidosis, Rheumatic Fever, MRSA infection, Nocardiosis, Pertussis(VVhooping Cough), Plague, Pneumococcal pneumonia, Psittacosis, Q fever,Rocky Mountain Spotted Fever (RMSF), Salmonellosis, Scarlet Fever,Shigellosis, Syphilis, Tetanus, Trachoma, Tuberculosis, Tularemia,Typhoid Fever, Typhus, and Urinary Tract Infections. It is an object ofthe present invention to provide a vaccine for the treatment and/orprevention and/or reduction of risk from a bacterial infection.

It is a further aspect of the present invention to provide a vaccinecomposition for the treatment and/or prevention and/or reduction of riskfrom: Parasitic infectious diseases such as, but not limited to: Africantrypanosomiasis, Amebiasis, Ascariasis, Babesiosis, Chagas Disease,Clonorchiasis, Cryptosporidiosis, Cysticercosis, Diphyllobothriasis,Dracunculiasis, Echinococcosis, Enterobiasis, Fascioliasis,Fasciolopsiasis, Filariasis, Free-living amebic infection, Giardiasis,Gnathostomiasis, Hymenolepiasis, Isosporiasis, Kala-azar, Leishmaniasis,Malaria, Metagonimiasis, Myiasis, Onchocerciasis, Pediculosis, PinwormInfection, Scabies, Schistosomiasis, Taeniasis, Toxocariasis,Toxoplasmosis, Trichinellosis, Trichinosis, Trichuriasis,Trichomoniasis, and Trypanosomiasis; Fungal infectious diseases such asbut not limited to: Aspergillosis, Blastomycosis, Candidiasis,Coccidioidomycosis, Cryptococcosis, Histoplasmosis, Tinea pedis; Prioninfectious diseases such as but not limited to: transmissible spongiformencephalopathy, Bovine spongiform encephalopathy, Creutzfeldt-Jakobdisease, Kuru—Fatal Familial Insomnia, and Alpers Syndrome; thus it isan object of the present invention to be administered as the treatmentof or as part of the treatment of these parasitic, fungal or prioncaused infections.

Infectious Disease Combination Treatment

It is further provided for that a treatment of any infectious disease bythe administration of the vaccine composition according to the presentinvention may be given in conjunction with a further (second) activeingredient or in combination with a further treatment such as antibiotictreatment, chemotherapy, treatment with immuno-stimulating substances,treatment using dendritic cells, antiviral agents anti parasitic agentsand so forth.

Examples of a second active ingredient that may be used in the treatmentof an infectious disease in combination with the vaccine of the presentinvention include, and are not limited to antibiotics. The termantibiotics herein refers to substances with anti-bacterial,anti-fungal, anti-viral and/or anti-parasitical activity; examples ofrelevance to the present invention include, but are not limited to:Amikacin, Gentamycin, Kanamycin, Neomycin, Netilmicin, Paromomycin,Streptomycin, Tobramycin, Ertapenem, Imipenem, Meropenem,Chloramphenicol, Fluoroquinolones, Ciprofloxacin, Gatifloxacin,Gemifloxacin, Grepafloxacin, Levofloxacin, Lomefloxacin, Moxifloxacin,Norfloxacin, Ofloxacin, Sparfloxacin, Trovafloxacin, Glycopeptides,Vancomycin, Lincosamides, Clindamycin, Macrolides/Ketolides,Azithromycin, Clarithromycin, Dirithromycin, Erythromycin, Cefadroxil,Cefazolin, Cephalexin, Cephalothin, Cephapirin, Cephradine, Cefaclor,Cefamandole, Cefonicid, Cefotetan, Cefoxitin, Cefprozil, Cefuroxime,Loracarbef, Cefdinir, Cefditoren, Cefixime, Cefoperazone, Cefotaxime,Cefpodoxime, Ceftazidime, Ceftibuten, Ceftizoxime, Ceftriaxone,Cefepime, Monobactams, Aztreonam, Nitroimidazoles, Metronidazole,Oxazolidinones, Linezolid, Penicillins, Amoxicillin,Amoxicillin/Clavulanate, Ampicillin, Sulbactam, Bacampicillin,Carbenicillin, Cloxacillin, Dicloxacillin, Methicillin, Mezlocillin,Nafcillin, Oxacillin, Penicillin G, Penicillin V, Piperacillin,Piperacillin/Tazobactam, Ticarcillin, Ticarcillin/Clavulanate,Streptogramins, Quinupristin, Dalfopristin,Sulfonamide/Sulfamethoxazole, Trimethoprim, Tetracyclines,Demeclocycline, Doxycycline, Minocycline, Tetracycline, Azoleantifungals Clotrimazole Fluconazole, Itraconazole, Ketoconazole,Miconazole, Voriconazole, Amphotericin B, Nystatin, Echinocandin,Caspofungin, Micafungin, Ciclopirox, Flucytosine, Griseofulvin, andTerbinafine. Of further relevance are antivirals such as Vidarabine,Acyclovir, Gancyclovir and Valcyte (valganciclovir), Nucleoside-analogreverse transcriptase inhibitors (NRTI): AZT (Zidovudine), ddl(Didanosine), ddC (Zalcitabine), d4T (Stavudine), 3TC (Lamivudine),Non-nucleoside reverse transcriptase inhibitors (NNRTI): Nevirapine,Delavirdine, Protease Inhibitors: Saquinavir, Ritonavir, Indinavir,Nelfinavir, Ribavirin, Amantadine/Rimantadine, Relenza and Tamiflu,Pleconaril, Interferons

In an embodiment, the present invention regards a vaccine compositioncomprising TDO derived proteins, polypeptides and/or functional homologsof these for the treatment of an infectious disease in combination withat least one antibiotic. Preferably, the vaccine composition of thepresent invention is used for the treatment of chronic infections e.g.HIV and therefore is used in combination with any of the above listedantibiotics such as anti-viral agents.

Autoimmune Diseases

Autoimmune diseases arise when an organism fails to recognize its ownconstituent parts (down to the sub-molecular levels) as self, whichresults in an immune response against its own cells and tissues. Anydisease that results from such an aberrant immune response is termed anautoimmune disease and is of relevance to the present invention.Examples hereof include but are not limited to: Coeliac disease,diabetes mellitus type 1 (IDDM), systemic lupus erythematosus (SLE),Sjogren's syndrome, multiple sclerosis (MS), Hashimoto's thyroiditis,Graves' disease, idiopathic thrombocytopenic purpura, and rheumatoidarthritis (RA).

It is an object of the present invention to provide a vaccinecomposition comprising Tryptophan 2,3-dioxygenase (TDO) of SEQ ID NO:1or a functional homologue thereof having at least 70% identity to SEQ IDNO: 1 or an immunogenically active peptide fragment comprising aconsecutive sequence of said TDO or said functional homologue thereof ora nucleic acid encoding said TDO or said peptide fragment; and anadjuvant, for the prevention of, reduction of risk from or treatment ofautoimmune diseases.

Autoimmune Disease Combination Treatment

Current treatments for autoimmune disease are usually immunosuppressive,anti-inflammatory, or palliative. Non-immune therapies, such as hormonereplacement in Hashimoto's thyroiditis or diabetes mellitus Type 1treatment outcomes of the auto-aggressive response. Dietary manipulationlimits the severity of celiac disease. Steroidal or NSAID treatmentlimits inflammatory symptoms of many diseases. Intravenous preparationsof immune globulin (IVIG) are used for Chronic InflammatoryDemyelinating Polyneuropathy (CIDP) and Guillain-Barré syndrome (GBS).More specific immunomodulatory therapies, such as the TNFα antagonistEtanercept, have been shown to be useful in treating RA. Theseimmunotherapies may be associated with increased risk of adverseeffects, such as susceptibility to infection.

Helminthic therapy has developed based on these observations andinvolves inoculation of the individual with specific parasiticintestinal nematodes (helminths).

There are currently two closely-related treatments available,inoculation with either Necator americanus, commonly known as hookworms,or Trichuris Suis Ova, commonly known as Pig Whipworm Eggs. Research isavailable that demonstrates this approach is highly effective intreating a variety of autoimmune disorders, including Crohn's,Ulcerative Colitis, Asthma, allergies, Multiple Sclerosis, and chronicinflammatory disorders

In an embodiment, the vaccine herein disclosed is used in combinationwith a second active ingredient such as any of the above mentioned drugsand treatments against autoimmune diseases.

Allergic Inflammation

Allergy is a disorder of the immune system often also referred to asatopy. Allergic reactions occur to environmental substances known asallergens; these reactions are acquired, predictable and rapid.Strictly, allergy is one of four forms of hypersensitivity and is calledtype I (or immediate) hypersensitivity. It is characterized by excessiveactivation of certain white blood cells called mast cells and basophilsby a type of antibody, known as IgE, resulting in an extremeinflammatory response. Common allergic reactions include eczema, hives,hay fever, asthma, food allergies, and reactions to the venom ofstinging insects such as wasps and bees.

Allergic inflammation is an important pathophysiological feature ofseveral disabilities or medical conditions including allergic asthma,atopic dermatitis, allergic rhinitis and several ocular allergicdiseases.

It is an object of the present invention to provide a vaccinecomposition comprising Tryptophan 2,3-dioxygenase (TDO) of SEQ ID NO: 1or a functional homologue thereof having at least 70% identity to SEQ IDNO: 1 or an immunogenically active peptide fragment comprising aconsecutive sequence of said TDO or said functional homologue thereof ora nucleic acid encoding said TDO or said peptide fragment; and anadjuvant, for the prevention of, reduction of risk from or treatment ofallergic inflammation.

Allergic Inflammation Combination Treatment

Two types of treatments are available for the treatment of allergicinflammations, pharmacotherapy and immunotherapy: pharmacotherapy andimmunotherapy.

Pharmacotherapy, is the use of antagonistic drugs to block the action ofallergic mediators, or to prevent activation of cells and degranulationprocesses. These include antihistamines, cortisone, dexamethasone,hydrocortisone, epinephrine (adrenaline), theophylline, cromolyn sodiumand anti-leukotrienes, such as Montelukast (Singulair) or Zafirlukast(Accolate); anti-cholinergics, decongestants, mast cell stabilizers, andother compounds thought to impair eosinophil chemotaxis, are alsocommonly used.

Immunotherapy is the desensitization or hyposensitization treatment inwhich the individual is gradually vaccinated with progressively largerdoses of the allergen in question. A second form of immunotherapyinvolves the intravenous injection of monoclonal anti-IgE antibodies. Athird type, Sublingual immunotherapy, is an orally-administered therapywhich takes advantage of oral immune tolerance to non-pathogenicantigens such as foods and resident bacteria.

In an embodiment, the vaccine herein disclosed is used in combinationwith a second active ingredient such as any of the above mentioned drugsand treatments against allergic inflammations.

Pharmaceutical Compositions

The present invention regards pharmaceutical compositions capable oftreating, reducing the risk of and/or preventing a clinical disorderassociated with TDO expression in an individual. Said pharmaceuticalcomposition may in particular be a vaccine composition. The vaccinecompositions of the present invention may be “traditional” vaccinecompositions comprising antigens such as proteins polypeptides and/ornucleic acid molecules. They may also be in the form of compositionscomprising cells, such as modified cells originating from the individualand later processed, or to compositions comprising complex moleculessuch as antibodies or TCRs.

Generally, a vaccine is a substance or composition capable of inducingan immune response in an individual. The composition may comprise one ormore of the following: an “active component” such as an antigen(s) (e.g.protein, polypeptides, peptides, nucleic acids and the like), nucleicacid constructs comprising one or more antigens amongst other elements,cells, (e.g. loaded APC or T cells for adoptive transfer), complexmolecules (Antibodies, TCRs and MHC complexes and more), carriers,adjuvants and pharmaceutical carriers. In the following, the variouscomponents of a vaccine composition according to the present inventionare disclosed in more detail.

The vaccine composition of the invention is capable of eliciting animmune response against a cancer, DC or APC expressing TDO of SEQ ID NO:1 or a functional homologue thereof having at least 70% identity to SEQID NO 1, when administered to an individual suffering from a cancerand/or infection (leading to the expression of TDO). In a preferredembodiment the clinical condition is a cancer. The vaccine compositionof the invention is capable of eliciting the production in a vaccinatedindividual of effector T-cells having a cytotoxic effect against cancercells, APCs and DCs expressing TDO and/or inducing infiltration ofantigen specific T-cells in tumor stroma in a subject.

Antigens and Other Active Components

Protein/Polypeptide Based Vaccine Compositions

The peptides of the present invention bind with surprisingly highaffinity (see FIG. 2) and are ready for use as antigens as they arepresented here. Preferably, the vaccine composition of the presentinvention comprises one or more of the following:

-   -   1) Tryptophan 2,3-dioxygenase (TDO), which may be any of the        TDOs described herein below in the section “Tryptophan        2,3-dioxygenase”;    -   2) An immunogenically active peptide fragment of TDO comprising        a consecutive sequence of amino acids of TDO, which may be any        of the peptides described herein below in the section        “Immunogenically active peptide fragment of TDO”.    -   3) An immunogenically active peptide fragments of TDO, which is        an MHC Class I-restricted peptide fragment or MHC Class        II-restricted peptide fragment, such as any of the an MHC Class        I-restricted peptide fragments or MHC Class II-restricted        peptide fragments described in the section “MHC”;    -   4) A functional homologue of the polypeptides under 1), 2) and        3);    -   5) A polypeptide comprising any of polypeptides under 1), 2), 3)        and 4), which may be any of the polypeptides described herein        below in the section “Polypeptides comprising TDO or a fragment        thereof”;    -   6) A nucleic acid encoding any of the polypeptides under 1),        2), 3) and 4).

The choice of antigen in the vaccine composition of the invention willdepend on parameters determinable by the person of skill in the art. Asit has been mentioned, each of the different peptides of the inventionis presented on the cell surfaces by a particular HLA molecule. As such,if a subject to be treated is typed with respect to HLA phenotype, apeptide/peptides are selected that is/are known to bind to thatparticular HLA molecule. Alternatively, the antigen of interest isselected based on the prevalence of the various HLA phenotypes in agiven population. As an example, HLA-A2 is the most prevalent phenotypein the Caucasian population, and therefore, a composition containing apeptide binding to HLA-A2 will be active in a large proportion of thatpopulation. Furthermore, the antigens/peptides of the present inventionmay be modified according to the anchor residue motifs presented inTable 2, to enhance binding to particular HLA molecules.

The composition of the invention may also contain a combination of twoor more immunogenically active peptide fragments of TDO, e.g. any of thepeptides described in the sections “Immunogenically active peptidefragments of TDO”, “Polypeptides comprising TDO or a fragment thereof”and “MHC”. Said immunogenically active peptide fragments of TDO may eachinteract specifically with a different HLA molecule so as to cover alarger proportion of the target population. Thus, as examples, thepharmaceutical composition may contain a combination of a peptiderestricted by a HLA-A molecule and a peptide restricted by a HLA-Bmolecule, e.g. including those HLA-A and HLA-B molecules that correspondto the prevalence of HLA phenotypes in the target population, such ase.g. HLA-A2 and HLA-B35. Additionally, the composition may comprise apeptide restricted by an HLA-C molecule.

In the case of peptide-based vaccines, epitopes can be administered inan ‘MHC-ready’ form, which enables presentation through exogenousloading independently of antigen uptake and processing by hostantigen-presenting cells. The peptides of the present invention compriseboth peptides in a short ‘MHC-ready’ form and in a longer form requiringprocessing by the proteasome thus providing a more complex vaccinecomposition that can target multiple tumor antigens. The more differentHLA groups are targeted by a vaccine, the higher likelihood of thevaccine functioning in diverse populations.

Multi Epitope Vaccine Composition

The invention also relates to highly immunogenic multi-epitope vaccines.Preferably, such vaccines should be designed so as to facilitate asimultaneous delivery of the best-suited immunogenically active peptidefragments of TDO optionally in combination with other suitable peptidesand/or adjuvants as described hereinafter. The present inventionencompasses such multiepitope vaccines comprising immunogenically activepeptide fragments of TDO optionally in combination with further proteinsor peptides fragments not belonging to or derived from TDO and/oradjuvants as described hereinafter. An important factor driving thedevelopment of vaccines having a more complex composition is the desireto target multiple tumor antigens e.g. by designing vaccines comprisingor encoding a collection of carefully selected CTL and T_(h) cellepitopes. The invention thus in one aspect relates to vaccinecompositions comprising both Class I and Class II-restricted TDOepitopes.

The peptides of the present invention thus comprise both peptides in ashort ‘MHC-ready’ form (class I restricted), and in a longer formrequiring processing by the proteasome (class II restricted). Thus, thecomposition according to the present invention may be provided as amultiepitope vaccine comprising class I restricted epitope and/or classII restricted epitopes as defined hereinbefore.

Nucleic Acid Based Vaccine Composition

The vaccine composition according to the present invention may comprisea nucleic acid encoding a TDO polypeptide or an immunologically activepeptide fragment thereof. Said nucleic acid may thus encode any of theabove-mentioned proteins and peptide fragments. The nucleic acid may forexample be DNA, RNA, LNA, HNA, PNA, preferably the nucleic acid is DNAor RNA.

The nucleic acids of the invention may be comprised within any suitablevector, such as an expression vector. Numerous vectors are available andthe skilled person will be able to select a useful vector for thespecific purpose. The vector may, for example, be in the form of aplasmid, cosmid, viral particle or artificial chromosome. Theappropriate nucleic acid sequence may be inserted into the vector by avariety of procedures, for example, DNA may be inserted into anappropriate restriction endonuclease site(s) using techniques well knownin the art. Apart from the nucleic acid sequence according to theinvention, the vector may furthermore comprise one or more of a signalsequence, an origin of replication, one or more marker genes, anenhancer element, a promoter, and a transcription termination sequence.The vector may also comprise additional sequences, such as enhancers,poly-A tails, linkers, polylinkers, operative linkers, multiple cloningsites (MCS), STOP codons, internal ribosomal entry sites (IRES) and hosthomologous sequences for integration or other defined elements. Methodsfor engineering nucleic acid constructs are well known in the art (see,e.g., Molecular Cloning: A Laboratory Manual, Sambrook et al., eds.,Cold Spring Harbor Laboratory, 2nd Edition, Cold Spring Harbor, N.Y.,1989). The vector is preferably an expression vector, comprising thenucleic acid operably linked to a regulatory nucleic acid sequencedirecting expression thereof in a suitable cell. Within the scope of thepresent invention said regulatory nucleic acid sequence should ingeneral be capable of directing expression in a mammalian cell,preferably a human cell, more preferably in an antigen presenting cell.

In one preferred embodiment the vector is a viral vector. The vector mayalso be a bacterial vector, such as an attenuated bacterial vector.Attenuated bacterial vectors may be used in order to induce lastingmucosal immune responses at the sites of infection and persistence.Different recombinant bacteria may be used as vectors, for example thebacterial vector may be selected from the group consisting ofSalmonella, Lactococcus], and Listeria. In general, induction ofimmunity to the heterologous antigen HPV16 L1 or E7 could be shown, withstrong CTL induction and tumor regression in mice. The vector mayfurthermore comprise a nucleic acid encoding a T-cell stimulatorypolypeptide.

Loaded APCs

In useful embodiments an immunogenic response directed against a cancerdisease is elicited by administering the peptide of the invention eitherby loading MHC class I or class II molecules on antigen presenting cells(APCs) from the individual, by isolating PBLs from the individual andincubating the cells with the peptide prior to injecting the cells backinto the individual or by isolating precursor APCs from the individualand differentiating the cells into professional APCs using cytokines andantigen before injecting the cells back into the individual.

It is thus an aspect of the invention to provide vaccine compositionscomprising antigen presenting cells comprising TDO or an immunologicallyactive peptide fragment thereof or a nucleic acid encoding said proteinor said immunologically active peptide fragment. The antigen presentingcell may be any cell capable of presenting an antigen to a T-cell.Preferred antigen presenting cells are dendritic cells. The dendriticcells (DC) may be prepared and used in therapeutic procedure accordingto any suitable protocol, for example as described herein below. It willbe appreciated by the person skilled in the art that the protocol may beadopted to use with individuals with different HLA type and differentdiseases.

Dendritic cells (DC) may be pulsed with 50 μg/ml HLA-restricted peptide(synthesized at GMP quality) for 1 h at 37° C. peptide and 5×10⁶ cellsare administered sub-cutaneously at day 1 and 14, subsequently every 4weeks, additional leukapheresis after 5 vaccinations. The generation ofDC for clinical use and quality control can be performed essentially asdescribed in Nicolette et al., (2007).

Thus, in one embodiment of the present invention, a method for treatingan individual suffering from a clinical condition characterized by theexpression of TDO, preferably wherein the clinical condition is canceror an infection, is one wherein the peptide is administered bypresenting the peptide to the individual's antigen presenting cells(APCs) ex vivo followed by injecting the thus treated APCs back into theindividual. There are at least two alternative ways of performing this.One alternative is to isolate APCs from the individual and incubate(load) the MHC class I molecules with the peptide. Loading the MHC classI molecules means incubating the APCs with the peptide so that the APCswith MHC class I molecules specific for the peptide will bind thepeptide and therefore be able to present it to T cells. Subsequently,the APCs are re-injected into the individual. Another alternative wayrelies on the recent discoveries made in the field of dendritic cellbiology. In this case, monocytes (being dendritic cell precursors) areisolated from the individual and differentiated in vitro intoprofessional APC (or dendritic cells) by use of cytokines and antigen.Subsequently, the in vitro generated DCs are pulsed with the peptide andinjected into the individual.

Adoptive Immunotherapy/Adoptive Transfer

An important aspect the invention relates to cultivating TDO specificT-cells in vitro and adoptive transfer of these to individuals. Adoptivetransfer means that the physician directly transfers the actualcomponents of the immune system that are already capable of producing aspecific immune response, into an individual.

It is one objective to the present invention to provide TDO specificT-cells, which may be useful for example for adoptive transfer. IsolatedT-cells comprising T-cell receptors capable of binding specifically toTDO peptide/MHC class I or TDO peptide/MHC class II complexes can beadoptively transferred to individuals, said T-cells preferably beingT-cells that have been expanded in vitro, wherein the TDO peptide may beany of the immunogenically active peptide fragments of TDO mentionedherein above. Methods of expanding T-cells in vitro are well known tothe skilled person. The invention also relates to methods of treatmentcomprising administering T-cells comprising T-cell receptors capable ofbinding specifically to a MHC-restricted TDO peptide complex to anindividual, such as a human being suffering from a cancer disease,wherein the TDO derived peptide may be any of the TDO peptides mentionedherein above. The invention furthermore relates to use of T-cellscomprising T-cell receptors capable of binding specifically to TDO orpeptide fragments thereof for the preparation of a medicament for thetreatment of a cancer or infection. Autologous T-cell transfer may beperformed essentially as described in Walter et al., (1995).

TCR Transfer

In yet another embodiment, such T-cells could be irradiated beforeadoptive transfer to control proliferation in the individual. It ispossible to genetically engineer the specificity of T cells by TCR genetransfer (Engels et al., 2007). This allows the transfer of T cellsbearing TDO peptide specificity into individuals. In general, the use ofT cells for adoptive immunotherapy is attractive because it allows theexpansion of T cells in a tumor- or virus-free environment, and theanalysis of T cell function prior to infusion. The application of TCRgene-modified T cells (such as T-cells transformed with an expressionconstruct directing expressing of a heterologous TCR) in adoptivetransfer has several advantages in comparison to the transfer of T celllines: (i) the generation of redirected T cells is generally applicable.(ii) High-affinity or very high-affinity TCRs can be selected or createdand used to engineer T cells. (iii) High-avidity T cells can begenerated using codon optimized or murinized TCRs allowing bettersurface expression of the stabilized TCRs. Genetic engineering of T cellspecificity by T cell receptor (TCR) gene transfer may be performedessentially as described in Morgan et al., (2006).

TCR Transfection

TCR with known anti-tumor reactivity can be genetically introduced intoprimary human T lymphocytes. Genes encoding TCR alpha and beta chainsfrom a tumor specific CTL clone can be transfected into primary T cellsand in this way reprogram T cells with specificity against the tumorantigen. TCR RNA is transfected into PBL by electroporation (Schaft etal., 2006). Alternatively, T cells can be provided with at newspecificity by TCR gene transfer using retroviral vectors (Morgan etal., 2006). However, the provirus from the retroviral vector mightintegrate at random in the genome of the transfected cells andsubsequently disturb cell growth. Electroporation of T cells withTCR-coding RNA overcome this disadvantage, since RNA is only transientlypresent in the transfected cells and cannot be integrated in the genome(Schaft et al., 2006). Furthermore, transfection of cells is routinelyused in the laboratory.

Adjuvants and Carriers

The vaccine composition according to the invention preferably comprisesan adjuvant and/or a carrier. Examples of useful adjuvants and carriersare given herein below. Thus the TDO polypeptide, the immunogenicallyactive peptide fragments of TDO or functional homologues thereof, thepolypeptides comprising same or nucleic acid encoding same may in acomposition of the present invention be associated with an adjuvantand/or a carrier.

Adjuvants are any substance whose admixture into the vaccine compositionincreases or otherwise modifies the immune response to the TDO or toimmunogenically active peptide fragments of TDO, see further in thebelow. Carriers are scaffold structures, for example a polypeptide or apolysaccharide, to which the TDO or peptide fragment thereof is capableof being associated and which aids in the presentation of especially thepeptides of the present invention.

Many of the peptides of the invention are relatively small molecules andit may therefore be required in compositions as described herein tocombine the peptides with various materials such as adjuvants and/orcarriers, to produce vaccines, immunogenic compositions, etc. Adjuvants,broadly defined, are substances which promote immune responses. Ageneral discussion of adjuvants is provided in Goding, Monoclonal

Antibodies: Principles & Practice (2nd edition, 1986) at pages 61-63.Goding notes, that when the antigen of interest is of low molecularweight, or is poorly immunogenic, coupling to an immunogenic carrier isrecommended. Examples of such carrier molecules include keyhole limpethaemocyanin, bovine serum albumin, ovalbumin and fowl immunoglobulin.Various saponin extracts have also been suggested to be useful asadjuvants in immunogenic compositions. It has been proposed to usegranulocyte-macrophage colony stimulating factor (GM-CSF), a well-knowncytokine, as an adjuvant (WO 97/28816).

A carrier may be present independently of an adjuvant. The function of acarrier can for example be to increase the molecular weight of inparticular peptide fragments in order to increase their activity orimmunogenicity, to confer stability, to increase the biologicalactivity, or to increase serum half-life. Furthermore, a carrier may aidin presenting the TDO protein, polypeptide, functional homologue orpeptide fragments thereof to T-cells. The carrier may be any suitablecarrier known to a person skilled in the art, for example a protein oran antigen presenting cell. A carrier protein could be, but is notlimited to, keyhole limpet hemocyanin, serum proteins such astransferrin, bovine serum albumin, human serum albumin, thyroglobulin orovalbumin, immunoglobulins, or hormones, such as insulin or palmiticacid. For immunization of humans, the carrier must be a physiologicallyacceptable carrier acceptable to humans and safe. However, tetanustoxoid and/or diptheria toxoid are suitable carriers in one embodimentof the invention. Alternatively, the carrier may be dextrans for examplesepharose.

Thus it is an aspect of the present invention that the TDO protein,polypeptide fragment, variant or peptide derived here from present inthe composition is associated with a carrier such as e.g. a protein ofthe above or an antigen-presenting cell such as e.g. a dendritic cell(DC).

Adjuvants could for example be selected from the group consisting of:AlK(SO₄)₂, AlNa(SO₄)₂, AlNH₄ (SO₄), silica, alum, Al(OH)₃, Ca₃ (PO₄)₂,kaolin, carbon, aluminum hydroxide, muramyl dipeptides,N-acetyl-muramyl-L-threonyl-D-isoglutamine (thr-DMP),N-acetyl-nornuramyl-L-alanyl-D-isoglutamine (CGP 11687, also referred toas nor-MDP),N-acetylmuramyul-L-alanyl-D-isoglutaminyl-L-alanine-2-(1′2′-dipalmitoyl-sn-glycero-3-hydroxphosphoryloxy)-ethylamine(CGP 19835A, also referred to as MTP-PE), RIBI (MPL+TDM+CWS) in a 2%squalene/Tween-80.®. emulsion, lipopolysaccharides and its variousderivatives, including lipid A, Freund's Complete Adjuvant (FCA),Freund's Incomplete Adjuvants, Merck Adjuvant 65, polynucleotides (forexample, poly IC and poly AU acids), wax D from Mycobacterium,tuberculosis, substances found in Corynebacterium parvum, Bordetellapertussis, and members of the genus Brucella, Titermax, ISCOMS, Quil A,ALUN (see U.S. Pat. Nos. 58767 and 5,554,372), Lipid A derivatives,choleratoxin derivatives, HSP derivatives, LPS derivatives, syntheticpeptide matrixes or GMDP, Interleukin 1, Interleukin 2, Montanide ISA-51and QS-21. Preferred adjuvants to be used with the invention includeoil/surfactant based adjuvants such as Montanide adjuvants (availablefrom Seppic, Belgium), preferably Montanide ISA-51. Other preferredadjuvants are bacterial DNA based adjuvants, such as adjuvants includingCpG oligonucleotide sequences. Yet other preferred adjuvants are viraldsRNA based adjuvants, such as poly I:C. Imidazochinilines are yetanother example of preferred adjuvants. The most preferred adjuvants areadjuvants suitable for human use.

Montanide adjuvants (all available from Seppic, Belgium), may beselected from the group consisting of Montanide ISA-51, MontanideISA-50, Montanide ISA-70, Montanide ISA-206, Montanide ISA-25, MontanideISA-720, Montanide ISA-708, Montanide ISA-763A, Montanide ISA-207,Montanide ISA-264, Montanide ISA-27, Montanide ISA-35, Montanide ISA51F, Montanide ISA 016D and Montanide IMS, preferably from the groupconsisting of Montanide ISA-51, Montanide IMS and Montanide ISA-720,more preferably from the group consisting of Montanide ISA-51. MontanideISA-51 (Seppic, Inc.) is oil/surfactant based adjuvants in whichdifferent surfactants are combined with a non-metabolizable mineral oil,a metabolizable oil, or a mixture of the two. They are prepared for useas an emulsion with an aqueous solution comprising TDO or peptidefragment thereof. The surfactant is mannide oleate. QS-21 (Antigenics;Aquila Biopharmaceuticals, Framingham, Mass.) is a highly purified,water-soluble saponin that handles as an aqueous solution. QS-21 andMontanide ISA-51 adjuvants can be provided in sterile, single-use vials.

The well-known cytokine GM-CSF is another preferred adjuvant of thepresent invention. GM-CSF has been used as an adjuvant for a decade andmay preferably be GM-CSF as described in WO 97/28816.

Desirable functionalities of adjuvants capable of being used inaccordance with the present invention are listed in the below table.

TABLE 3 Modes of adjuvant action Action Adjuvant type Benefit 1. Immuno-Generally small molecules or proteins Upregulation of immune response.modulation which modify the cytokine network Selection of Th1 or Th2 2.Presentation Generally amphipathic molecules or Increased neutralizingantibody complexes which interact with response. Greater duration ofimmunogen in its native conformation response 3. CTL induction Particleswhich can bind or Cytosolic processing of protein enclose immunogen andwhich yielding correct class 1 restricted can fuse with or disrupt cellpeptides membranes w/o emulsions for direct Simple process ifpromiscuous attachment of peptide to cell peptide(s) known surface MHC-14. Targeting Particulate adjuvants which bind Efficient use of adjuvantand immunogen. Adjuvants which immunogen saturate Kupffer cellsCarbohydrate adjuvants which As above. May also determine target lectinreceptors on type of response if targeting macrophages and DCs selective5. Depot w/o emulsion for short term Efficiency Generation Microspheresor nanospheres for Potential for single-dose vaccine long term Source:Cox, J. C., and Coulter, A. R. (1997). Vaccine 15, 248-56.

A vaccine composition according to the present invention may comprisemore than one adjuvant. Furthermore, the invention encompasses atherapeutic composition further comprising any adjuvant substance and/orcarrier including any of the above or combinations thereof. It is alsocontemplated that the TDO protein, variants or peptide fragmentsthereof, and the adjuvant can be administered separately in anyappropriate sequence. Preferably, the vaccine compositions of thepresent invention comprise a Montanide adjuvant such as Montanide ISA 51or Montanide ISA 720 or the GM-CSF adjuvant.

Accordingly, the invention encompasses a therapeutic composition furthercomprising an adjuvant substance including any of the above orcombinations thereof. It is also contemplated that the antigen, i.e. thepeptide of the invention and the adjuvant can be administeredsimultaneously or separately in any appropriate sequence.

Dosis and Administration

The amount of TDO or the immunogenically active peptide fragments of TDOof the invention in the vaccine composition may vary, depending on theparticular application. However, a single dose of the peptidecomposition is preferably anywhere from about 10 μg to about 5000 μg,more preferably from about 50 μg to about 2500 μg such as about 100 μgto about 1000 μg. In particular, in embodiments of the invention wherethe individual to be treated is a human being, then a single dose may bein the range of 50 μg to 500 μg, for example in the range of 80 μg to300 μg, such as in the range of 100 μg to 250 μg of TDO or saidimmunogenically active peptide fragment of TDO. Frequently, the vaccinecompositions are administered repeatedly over time. For example thevaccine composition may be administered at least 2 times, preferably atleast 5 times, more preferably at least 10 times, such as in the rangeof 10 to 20 times. The vaccine composition may also be administeredcontinuously. Administration may be repeated at any useful frequency.Thus, for example the vaccine compositions may be administered onceevery week, such as once every two weeks, for example once every 3weeks, such as once per month, for example once per two months, such asonce per three months, for example once per half year, such as once peryear. In particular, the vaccine compositions may be administeredcontinuously. The frequency of administration may alter during saidtime. In one embodiment the vaccine compositions are administeredcontinuously once per 1 to 3 months. Modes of administration includeintradermal, subcutaneous and intravenous administration, implantationin the form of a time release formulation, etc. Any and all forms ofadministration known to the art are encompassed herein. Also any and allconventional dosage forms that are known in the art to be appropriatefor formulating injectable immunogenic peptide composition areencompassed, such as lyophilized forms and solutions, suspensions oremulsion forms containing, if required, conventional pharmaceuticallyacceptable carriers, diluents, preservatives, adjuvants, buffercomponents, etc.

The pharmaceutical compositions may be prepared and administered usingany conventional protocol known by a person skilled in the art. Inexamples 3-5 non-limiting examples of preparation of a vaccinecomposition according to the invention is given as well as anon-limiting example of administration of such as a vaccine. It will beappreciated by the person skilled in the art that the protocol may beeasily adapted to any of the vaccine compositions described herein. In afurther embodiment of the invention, the pharmaceutical composition ofthe invention is useful for treating an individual suffering from aclinical condition characterized by expression of TDO, such as cancerand infections.

The immunoprotective effect of the composition of the invention can bedetermined using several approaches known to those skilled in the art. Asuccessful immune response may also be determined by the occurrence ofDTH reactions after immunization and/or the detection of antibodiesspecifically recognizing the peptide(s) of the vaccine composition.

Vaccine compositions according to the invention may be administered toan individual in therapeutically effective amounts. The effective amountmay vary according to a variety of factors such as the individual'scondition, weight, sex and age. Other factors include the mode ofadministration.

The pharmaceutical compositions may be provided to the individual by avariety of routes such as subcutaneous, topical, oral and intramuscular.Administration of pharmaceutical compositions is accomplished orally orparenterally. Methods of parenteral delivery include topical,intra-arterial (directly to the tissue), intramuscular, subcutaneous,intramedullary, intrathecal, intraventricular, intravenous,intraperitoneal, or intranasal administration. The present inventionalso has the objective of providing suitable topical, oral, systemic andparenteral pharmaceutical formulations for use in the methods ofprophylaxis and treatment with the vaccine composition.

For example, the vaccine compositions can be administered in such oraldosage forms as tablets, capsules (each including timed release andsustained release formulations), pills, powders, granules, elixirs,tinctures, solutions, suspensions, syrups and emulsions, or byinjection. Likewise, they may also be administered in intravenous (bothbolus and infusion), intraperitoneal, subcutaneous, topical with orwithout occlusion, or intramuscular form, all using forms well known tothose of ordinary skill in the pharmaceutical arts. An effective butnon-toxic amount of the vaccine, comprising any of the herein describedcompounds can be employed as a prophylactic or therapeutic agent. Alsoany and all conventional dosage forms that are known in the art to beappropriate for formulating injectable immunogenic peptide compositionare encompassed, such as lyophilized forms and solutions, suspensions oremulsion forms containing, if required, conventional pharmaceuticallyacceptable carriers, diluents, preservatives, adjuvants, buffercomponents, etc.

Preferred modes of administration of the vaccine composition accordingto the invention include, but are not limited to systemicadministration, such as intravenous or subcutaneous administration,intradermal administration, intramuscular administration, intranasaladministration, oral administration, rectal administration, vaginaladministration, pulmonary administration and generally any form ofmucosal administration. Furthermore, it is within the scope of thepresent invention that the means for any of the administration formsmentioned in the herein are included in the present invention.

A vaccine according to the present invention can be administered once,or any number of times such as two, three, four or five times.Administering the vaccine more than once has the effect of boosting theresulting immune response. The vaccine can further be boosted byadministering the vaccine in a form or body part different from theprevious administration. The booster shot is either a homologous or aheterologous booster shot. A homologous booster shot is a where thefirst and subsequent vaccinations comprise the same constructs and morespecifically the same delivery vehicle especially the same viral vector.A heterologous booster shot is where identical constructs are comprisedwithin different viral vectors.

Second Active Ingredient

It is an aspect of the present invention that the vaccine compositionherein provided is used in combination with a second active ingredient.The administration of the vaccine composition and the second activeingredient may be sequential or combined. Examples of second activeingredients are given above for both cancers and infections. It is afurther aspect that the vaccine composition may be used in combinationwith other therapy of relevance for the given clinical condition to betreated. Such therapy may include surgery, chemotherapy or gene therapy,immunostimulating substances or antibodies; a person skilled in the artis able to determine the appropriate combination treatment for a givenscenario.

In some cases it will be appropriate to combine the treatment method ofthe invention with a further medical treatment such as chemotherapy,radiotherapy, treatment with immunostimulating substances, gene therapy,treatment with antibodies and/or antibiotics and treatment usingdendritic cells.

Diagnostic and Prognostic Tools

The peptides of the present invention provide the basis for developingwidely applicable diagnostic and prognostic procedures in respect ofcancer diseases and infections. Thus, in other useful embodiments thecomposition of the invention is a composition for ex vivo or in situdiagnosis of the presence of TDO expressing cells in an individual. Thediagnostic procedure is based on the detection of TDO reactive T cellsamong PBLs or in tumor tissue.

Accordingly, there is provided a diagnostic kit for ex vivo or in situdiagnosis of the presence in an individual of TDO reactive T cells amongPBLs or in tumour tissue comprising one or more peptides of theinvention, and a method of detecting in an individual the presence ofsuch reactive T cells, the method comprising contacting a tumour tissueor a blood sample with a complex of a peptide of the invention and aClass I or Class II HLA molecule or a fragment of such molecule anddetecting binding of the complex to the tissue or the blood cells. Inone aspect, the invention provides a complex of a peptide of theinvention and a Class I or Class II HLA molecule or a fragment of suchmolecule, which is useful as a diagnostic reagent such as it isdescribed herein. Such a complex may be monomeric or multimeric.

Another useful diagnostic or prognostic approach is based on generatingantibodies in a heterologous animal species, e.g. murine antibodiesdirected against a human immunogenically active peptide fragments of TDOof the invention, which can then be used, e.g. to diagnose for thepresence of cancer cells presenting the peptide. For such immunizationpurposes, the amount of peptide may be less than that used in the courseof in vivo therapy, such as that mentioned above. In general, apreferred dose can range from about 1 μg to about 750 μg of peptide. Itis also possible to produce monoclonal antibodies based on immunizationwith a peptide of the invention.

Accordingly, the present invention also relates to a molecule, inparticular a monoclonal or polyclonal antibody including a fragmenthereof, that is capable of binding specifically to a peptide of theinvention and to a molecule that is capable of blocking such a binding,e.g. an antibody raised against the monoclonal or polyclonal antibodydirected against a peptide of the invention. The invention furthermorerelates to isolated T-cell receptors capable of binding specifically toa peptide or a protein of the invention as well as to isolated nucleicacids encoding same. Such T-cell receptors may for example be clonedfrom protein or peptide specific T-cells using standard techniques wellknown to the skilled person.

In one aspect the invention also relates to isolated T-cells comprisingT-cell receptors capable of binding specifically to TDO and/or peptidefragments thereof described herein. The isolated T-cells may be CD8T-cells or CD4 T-cells. The isolated T-cells are preferably T-cells thathave been expanded in vitro. Methods of expanding T-cells in vitro arewell known to the skilled person. Such T-cells may in particular beuseful in the treatment of cancer by adaptive transfer or autologouscell transfer. Thus, the invention also relates to pharmaceuticalcompositions comprising T-cells as well as methods of treatmentcomprising administering T-cells comprising T-cell receptors capable ofbinding specifically to TDO or peptide fragments thereof to anindividual, in need thereof such as an individual suffering from cancerand/or infections. Autologous cell transfer may be performed essentiallyas described in Walter et al., (1995).

The present invention provides the means for treating, preventing,alleviating or curing a clinical condition characterized by expressionof TDO such as cancers and infections preferably a cancer, comprisingadministering to an individual suffering from the disease an effectiveamount of a composition as defined herein, a molecule that is capable ofbinding specifically to a peptide fragment, which may for example be anantibody or a T-cell receptor or the kit-of-parts described herein.Accordingly, it is a further aspect of the invention to provide a methodof treating a clinical condition associated with the expression of TDOof SEQ ID NO: 1. Said clinical condition may e.g. be cancer or aninflammatory condition.

Monitoring Immunization

In preferred embodiments, the pharmaceutical composition of theinvention is a vaccine composition. It is therefore of interest, and anaspect of the present invention to monitor the immunization in anindividual to whom the vaccine composition of the present invention isadministered. The pharmaceutical composition may thus be an immunogeniccomposition or vaccine capable of eliciting an immune response to acancer and/or infection. As used herein, the expression “immunogeniccomposition or vaccine” refers to a composition eliciting at least onetype of immune response directed against TDO expressing cells such ascancer cells, APCs or DCs. Thus, such an immune response may be any ofthe following: A CTL response where CTLs are generated that are capableof recognizing the HLA/peptide complex presented on cell surfacesresulting in cell lysis, i.e. the vaccine elicits the production in thevaccinated subject of effector T-cells having a cytotoxic effect againstthe cancer cells; a B-cell response giving rise to the production ofanti-cancer antibodies; and/or a DTH type of immune response. It is onobject of the present invention to monitor the immunization of anindividual by monitoring any of the above reactions subsequent toadministering the composition of the present invention to saidindividual.

In one aspect the invention relates to methods of monitoringimmunization, said method comprising the steps of

-   -   i) providing a blood sample from an individual    -   ii) providing TDO or a peptide fragment hereof, wherein said        protein or peptide may be any of the proteins or peptides        described herein    -   iii) determining whether said blood sample comprises antibodies        or T-cells comprising T-cell receptors specifically binding the        protein or peptide    -   iv) thereby determining whether an immune response to said        protein or peptide has been raised in said individual.

The individual is preferably a human being, for example a human beingthat has been immunized with TDO or immunogenically active peptidefragments of TDO or a nucleic acid encoding said protein or peptide.

Kit of Parts

The invention also relates to a kit-of-parts comprising

-   -   any of the vaccine compositions described herein and/or    -   an TDO protein or functional homologue hereof and/or    -   any of the immunogenically active peptide fragments of TDO,        functional homologues hereof, and/or peptides derived here from        as described herein and/or    -   any of the nucleic acids encoding the proteins of the above two        bullet points and instructions on how to use the kit of parts.

The invention also relates to a kit-of-parts comprising

-   -   any of the vaccine compositions described herein and/or    -   an TDO protein or functional homologue hereof and/or    -   any of the immunogenically active peptide fragments of TDO,        functional homologues hereof, and/or peptides derived here from        as described herein and/or    -   any of the nucleic acids encoding the proteins of the above two        bullet points and a second active ingredient.

Preferably, the second active ingredient is chosen in correspondencewith the clinical condition to be treated so that in the case where acancer is to be treated the second active ingredient is chosen amonge.g. chemotherapeutic agents as listed above. Likewise, if treating amicrobial/viral infection, the second active ingredient is preferably ananti-biotic and/or an anti-viral agent.

The components of the kit-of-parts are preferably comprised inindividual compositions, it is however within the scope of the presentinvention that the components of the kit-of-parts all are comprisedwithin the same composition. The components of the kit-of-parts may thusbe administered simultaneously or sequentially in any order.

Sequence Listing

SEQ ID NO Description SEQ ID NO: 1 Amino acid sequence of TDO of homosapiens SEQ ID NO: 2 Polypeptide fragment of human TDO, TDO₁₅₉₋₁₆₈ SEQID NO: 3 Polypeptide fragment of human TDO, TDO₂₀₀₋₂₀₈ SEQ ID NO: 4Polypeptide fragment of human TDO, TDO₇₂₋₈₁ SEQ ID NO: 5 Polypeptidefragment of human TDO, TDO₄₀₋₄₈ SEQ ID NO: 6 Polypeptide fragment ofhuman TDO, TDO₁₂₃₋₁₃₂ SEQ ID NO: 7 Polypeptide fragment of human TDO,TDO₆₅₋₇₄ SEQ ID NO: 8 Polypeptide fragment of human TDO, TDO₁₉₂₋₂₀₁ SEQID NO: 9 Polypeptide fragment of human TDO, TDO₃₀₉₋₃₁₇ SEQ ID NO: 10Polypeptide fragment of human TDO, TDO₈₅₋₉₃ SEQ ID NO: 11 Polypeptidefragment of human TDO, TDO₁₃₀₋₁₃₈ SEQ ID NO: 12 Polypeptide fragment ofhuman TDO, TDO₂₇₆₋₂₈₄ SEQ ID NO: 13 Polypeptide fragment of human TDO,TDO₃₆₄₋₃₇₂ SEQ ID NO: 14 Polypeptide fragment of human TDO, TDO₂₂₅₋₂₃₄SEQ ID NO: 15 Polypeptide fragment of human TDO, TDO₃₇₂₋₃₈₁ SEQ ID NO:16 Polypeptide fragment of human TDO, TDO₃₈₀₋₃₈₉ SEQ ID NO: 17Polypeptide fragment of human TDO, TDO₁₁₈₋₁₃₇ SEQ ID NO: 18 Polypeptidefragment of human TDO, TDO₃₀₃₋₃₂₂ SEQ ID NO: 19 Polypeptide fragment ofHIV, HIVpol₄₆₈₋₄₇₆ SEQ ID NO: 20 Polypeptide fragment of CMV pp65, CMVpp65₄₉₅₋₅₀₃

EXAMPLES

The invention is further illustrated by the following examples, whichshould however not be construed as limiting for the invention.

Example 1

In this example different TDO-derived epitopes that give rise to T cellreactivity are disclosed. Furthermore, spontaneous CD8⁺ and CD4⁺ T-cellmediated reactivity against TDO in both healthy donors and cancerpatients is described. However, interestingly the phenotype ofTDO-specific T cells varied between healthy individuals and patientswith a malignant disease.

Materials and Methods

Patients

Peripheral blood mononuclear cells (PBMC) were collected from patientswith Melanoma (MM), Breast Cancer (BC) and healthy donors (HD). Forcancer patients there was an at least 4 week interval between blooddraws and any kind of anticancer therapy. PBMCs were isolated usingLymphoprep separation, HLA-typed (Department of Clinical Immunology,University Hospital, Copenhagen, Denmark), and frozen in fetal calfserum (FCS) (Gibco, Naerum, Denmark) with 10% dimethyl sulfoxide (DMSO)(Sigma-Aldrich, Brøndby, Denmark). Written informed consent from thepatients was obtained before any of these measures. The protocol wasapproved by the scientific ethics committee for the Capital Region ofDenmark and conducted in accordance with the provisions of thedeclaration of Helsinki. HD PBMCs were obtained from the State Hospitalblood bank.

Tumor Cell Lines

Cell lines FM-55M1 and FM-86 were provided from EST-DAB(http://www.medizin.unituebingen.de/estdab/), A2058 and MDA-MB 231 wereobtained from ATCC (www.ATCC.org), UKE-1 (Zeeberg et al., 2013) was akind gift from W. Fiedler (University Hospital of Eppedorf, Hamburg,Germany). All cell lines were maintained in RPMI 1640 (Gibco) suppliedwith 10% FCS (Gibco).

Peptides

The TDO amino acid sequence was screened by the use of the publiclyavailable database SYFPEITHI for possible epitopes restricted to HLA-A2.Fifteen peptides were selected, synthesized by TAG Copenhagen(Copenhagen, Denmark). Once lyophilized peptides were dissolved in wateror DMSO (Sigma-Aldrich) according to the recommendation of themanufacturer, they were stored at −20 ° C. in aliquots avoidingfreeze-thaw cycles. The peptides were TDO₄₀₋₄₈(LIYGNYLHL)(SEQ ID NO:5),TDO₆₅₋₇₄ (KIHDEHLFII)(SEQ ID NO:7)), TDO₇₂₋₈₁ (FIITHQAYEL)(SEQ ID NO:4),TDO₈₅₋₉₃ (QILWELDSV)(SEQ ID NO:10) , TDO₁₂₃₋₁₃₂ (KLLVQQFSIL)(SEQ ID NO:6), TDO₁₃₀₋₁₃₈ (SILETMTAL)(SEQ ID NO:11), TDO₁₅₉₋₁₆₈ (RLLENKIGVL)(SEQ IDNO:2), TDO₁₉₂₋₂₀₁ (LLKSEQEKTL)(SEQ ID NO:8), TDO₂₀₀₋₂₀₈ (TLLELVEAWL)(SEQ ID NO:3), TDO₂₂₅₋₂₃₄ (KLEKNITRGL)(SEQ ID NO:14), TDO₂₇₆₋₂₈₄(LLSKGERRL)(SEQ ID NO:12), TDO₃₀₉₋₃₁₇ (QLLTSLMDI)(SEQ ID NO:9),TDO₃₆₄₋₃₇₂ (DLFNLSTYL)(SEQ ID NO:13), TDO₃₇₂₋₃₈₁ (LIPRHWIPKM)(SEQ IDNO:15) and TDO₃₈₀₋₃₈₉ (KMNPTIHKFL)(SEQ ID NO:16). For negative andpositive controls, the HIV derived peptide HIVpol₄₆₈₋₄₇₆ (ILKEPVHGV)(SEQID NO:19) and the CMV pp65 ₄₉₅₋₅₀₃ (NLVPMVATV)(SEQ ID NO:20) were used,respectively. Additionally, longer peptides (20 amino acids) comprisingTDO₁₂₃₋₁₃₂ and TDO₃₀₉₋₃₁₇, respectively, were synthesized. These werenamed TDO₁₁₈₋₁₃₇ (VSVILKLLVQQFSILETMTA)(SEQ ID NO:17) and TDO₃₀₃₋₃₂₂(RFQVPFQLLTSLMDIDSLMT)(SEQ ID NO:18) and both included several potentialclass II-restricted epitopes as suggested by the predictive algorithmSYFPEITHI.

HLA Peptide Exchange Technology and MHC ELISA

The HLA-peptide affinity was measured by a UV exchange method incombination with a sandwich ELISA as previously described (Toebes et al.2006). In short, HLA-A2 light and heavy chains were produced in E. Coliand refolded with a UV-sensitive ligand. This conditional ligand wascleaved upon 1 hour of UV light exposure and substituted with thepeptide of interest. After adding the HLA-A2-peptide complex to anELISA, the affinity of the complex was measured as the absorbance. Twopeptides with well described high affinity towards HLA-A2 (HIVpol₄₆₈₋₄₇₆and CMV pp65 ₄₉₅₋₅₀₃) were used as positive control peptides, while asample without substitution peptide was used as a negative control.Positive controls were made in quadruplicates and TDO peptides intriplicates.

ELISPOT Assay

In the present study the ELISPOT was performed according to theguidelines provided by CIP(http://cimt.eu/cimt/files/dl/cip_guidelines.pdf). The ELISPOT assay wasused to quantify peptide epitope specific effector cells that releasecytokines (IFNγ, TNFα, IL-17A or IL-10) as described previously(Sorensen et al., 2012). In some experiments, PBMCs were stimulated oncein vitro with peptide prior to analysis. In some experiments, 10⁴autologous DCs were added to the wells as antigen presenting cells. Thespots were counted using the ImmunoSpot Series 2.0 Analyzer(C.T.L.-Europe, Bonn, Germany). In some experiments, CD4⁺ cells wereisolated by EasySep human CD4⁺ T cell enrichment kit (Stem Celltechnologies, Grenoble, France) following manufacturers' instructions.This yielded highly pure cultures (>97% CD4⁺), which was confirmed bystaining with surface antibodies as described below for intracellularcytokine staining (ICS) and flow cytometry (FCM).

Definition of an ELISPOT response was either an empirical or statisticalapproach. The empirical approach is based on the “signal-to-noise” ratioand suggests that the threshold for response definition should bedefined as >6 specific spots per 10⁵ PBMCs. In the FIG. 6 we haveincreased this to >40 specific spots per 5×10⁵ PBMCs. The non-parametricdistribution free resampling (DFR) method allows statistical comparisonof antigen-stimulated wells and negative control wells as exemplified inFIG. 8. The release of a given cytokine in response to TDO₁₁₈₋₁₃₇ orTDO₃₀₃₋₃₂₂ was compared between patient and healthy donor groups by aMann-Whitney test. P-values <0,05 were considered significant.

Generation of TDO Specific T Cell Lines

DC were generated by adherence of PBMCs to the plastic surface of a wellfor one hour in RPMI 1640 (Gibco) before removal of non-adherent cells.The adherent cells were treated with 1000 U/ml GM-CSF (PeproTech,London, UK) and 250 U/ml IL-4 (Peprotech) in X-vivo 15 (Lonza,Copenhagen, Denmark) supplied with 5% human AB serum (Sigma-Aldrich) andplaced in a 37° C., 5% CO₂ and humidified environment. On day six,maturation cocktail consisting of 1000 U/ml of each TNFα, IL-1β and IL-6and 1 μg/ml PGE2 (Peprotech) was added to the cells. On day eight,mature DCs were harvested, loaded with 100 μM TDO peptide in X-vivo 15(Lonza) for four hours in the incubator. After washing, peptide-loadedDCs were mixed with autologous PBLs in X-vivo 15 (Lonza) supplied with5% human AB serum (Sigma-Aldrich). The next day, IL-12 and IL-7(Peprotech) were added to final concentrations of 20 and 40 U/ml,respectively. Cultures were stimulated this way twice seven days apart.Further stimulations were performed using autologous, irradiated (25 Gy)PBLs loaded with 100 μM TDO peptide. The day after stimulation with PBLsthe cultures were supplied with IL-2 (Proleukin; Novartis, Copenhagen,Denmark) to a final concentration of 40 U/ml.

FCM and Cell Sorting

Peptide loaded MHC tetramers were e ( ) were stained with 2,5 μl of eachphycoerytrhin (PE). No more than 2×10⁶ T cells were stained andallophycocyanin (APC) conjugated tetramers loaded with either a TDOpeptide or the HIVpol₄₆₈₋₄₇₆ peptide as a negative control were used.The stainings were performed in 50 μl PBS (Lonza) supplied with 2% FCS(Gibco) for 15 minutes in the incubator. Then an antibody mix consistingof αCD3-AmCyan, αCD4-Fitc (BD Bioscience, Albertslund, Denmark),aCD8-Pacific Blue (DAKO, Glostrup, Denmark) and the near IR Dead CellStain Kit (Life technologies, Naerum, Denmark) was added directly andthe cells placed at 4° C. in the dark for 30 minutes. After washing inPBS (Lonza) supplied with 2% FCS (Gibco), tetramer positive CD8⁺ cellswere sorted by FACS Aria (BD Biosciences). TDO-specific CD4⁺ T cellswere stimulated with 5 μM TDO₃₀₃₋₃₂₂ in X-vivo 15 medium (Lonza) andIFNy secreting cells were detected using MACS IFNy secretionassay-detection kit (PE) (Miltenyi Biotec, Lund, Sweden). PE positivecells were subsequently sorted into 10⁴ autologous, irradiated (30 Gy)PBMC by a FACS Aria (BD Biosciences).

Rapid Expansion Protocol (REP)

The rapid expansion of sorted specific T cells was performed as follows:Cells were rested in X-vivo 15 (Lonza) supplemented with 5% human serum(Sigma-Aldrich) and 6000 U/ml IL-2 (proleukin; Novartis) over night at5% CO2 at 37° C. The next day, feeder cells were prepared: a total of20*10⁶ PBLs from three healthy donors were irradiated (25 Gy), washedand mixed in a ratio of 1:1:1 in 2 ml X-vivo 15 (Lonza) containing 5%human serum (Sigma-Aldrich). After two hours, sample cells were mixedwith the feeder cells and IL-2 (Novartis) was added to a finalconcentration of 6000 U/ml along with αCD3 ab OKT3 (ebioscience,Frankfurt, Germany) to a final concentration of 30 ng/ml in 20 mlmedium. Every 3-4 days, cell numbers were adjusted to a maximum of 5*10⁵cells/ml and fresh IL-2 (Novartis) was added to 6000 U/ml.

Intracellular Cytokine Staining (ICS)

PBMCs were stimulated with 5 μM relevant peptide or control peptide inthe presence of GolgiPlug (diluted 1:1000, BD Biosciences) for fivehours in the incubator. Then, cells were washed twice in PBS (Lonza)supplied with 2% FCS (Gibco) and stained with surface antibodies asdescribed for cell sorting. After washing of cells in PBS (Lonza) withof 2% FCS (Gibco), cells were fixed and permeabilized withfixation/permebilization buffer (ebioscience) for at least 30 minutes,washed twice and then stained with antibodies specific for IFNy-PE (BDBiosciences) and TNFα-APC (ebioscience). At least 50.000 CD4⁺ T cellswere recorded on a FACS Canto II flow cytometer and data were analyzedwith the Diva software package (BD Biosciences).

Cytotoxicity Assay

Assessment of the cytotoxic capability of the generated T-cell lines wasevaluated using a conventional chromium release assay as described.Briefly, target tumor cell lines were labeled with 100 μCi ⁵¹Cr (PerkinElmer, Skovlunde, Denmark) in 100 μl RPMI 1640 (Gibco) supplied with 10%FCS (Gibco) for one hour at 37° C. After washing of target cells, theywere incubated with effector cells at different effector:target (E:T)ratios for four hours in the incubator. Subsequently, the amount ofradioactivity in the supernatant was measured using a gamma cell counter(Perkin Elmer Wallac Wizard 1470 Automatic gamma counter).

Results

Presence of TDO-Reactive CD8+ T Cell in Peripheral Blood of HealthyDonors and Cancer Patients

Potential HLA-A2-restricted T-cell epitopes derived from the TDO aminoacid sequence were identified based on the well-defined H LA-bindingmotif (Rammensee et al., 1999). The fifteen 9- to 10-mer peptides withthe highest predicted binding affinity were synthesized and subsequentlyused to screen PBMC from six cancer patients for the presence ofspontaneous T-cell responses by means of the ELISPOT assay. Thisanalysis revealed the presence of IFNγ producing T-cell in response tothe peptides TDO₁₂₃₋₁₃₂(KLLVQQFSIL)(SEQ ID NO:6), TDO₂₀₀₋₂₀₈,(TLLELVEAWL)(SEQ ID NO:3), TDO₃₀₉₋₃₁₇(QLLTSLMDI)(SEQ ID NO:9), andTDO₃₆₄₋₃₇₂ (DLFNLSTYL)(SEQ ID NO:13) after one round of in vitrostimulation (see FIG. 1A). Notably, for several of these peptides T-cellresponses were detected in more than one patient. Prompted by theseencouraging observations, we used four TDO-derived HLA-A2-restrictedT-cell epitopes to analyze PBMCs obtained from 14 additional cancerpatients as well as PBMCs from 14 healthy donors for the presence ofTDO-reactive T cells; again analyses were performed after one round ofin vitro stimulation. As depicted in FIG. 1, T-cell responses weredetected against all four peptides both in cancer patients as well as inhealthy donors. Surprisingly, the magnitude and frequency of responseswere similar in both groups. The non-parametric distribution freeresampling (DFR) method allows statistical comparison ofantigen-stimulated wells and negative control. Examples of significantresponses are given in supplementary FIG. 1. Moreover, TDO-reactive Tcells were detected directly ex vivo (see FIG. 8).

Generation and Functional Characterization of TDO-specific CD8⁺ T-CellLines

The detection and characterization of specific CD8+ T cells wasrevolutionized by the introduction of soluble peptide/MHC complexes(Rammensee et al., 1999). To establish TDO-specific CD8+ T cell lines,we repeatedly stimulated PBMCs from a cancer patient with autologousdendritic cells loaded with the TDO peptides TDO₁₂₃₋₁₃₂ or TDO₃₀₉₋₃₁₇ 5-or 4-times respectively. These in vitro stimulations dramaticallyincreased the frequency of TDO-specific CD8⁺ T cells as measured by twocolor tetramer staining (see FIG. 2). For further expansion by means ofthe rapid expansion protocol (REP) TDO₁₂₃₋₁₃₂ and TDO₃₀₉₋₃₁₇ reactive Tcells were enriched by fluorescence-activated cell sorting. Afterapplying REP the specificity of the resulting T-cell lines was confirmedby tetramer staining demonstrating 97.1% and 99.6% purity (see FIG. 2).These T-cell lines were tested for their capabilities to lyse eitherTAP-deficient peptide-pulsed T2 cells or H LA-matched TDO-expressingtumor cells. As depicted in FIG. 3A and B, TDO-specific T-cell cultureseffectively lysed T2 cells when these had been pulsed with the same TDOpeptide used for expansion, but not T2 cells pulsed with an irrelevantdifferent TDO-derived peptide. Most important, TDO-specific T cellsefficiently lysed HLA-A2⁺ cancer cell lines of different tissue origin,but not HLA-A2⁻ cancer cells (see FIGS. 3C and D). The lysis ofTDO-expressing cancer cell lines was not uniform. Specifically, thebreast cancer cell line MDA-MB 231 was killed by both TDO₁₂₃₋₁₃₂ andTDO₃₀₉₋₃₁₇ specific T-cell lines; the latter T-cell line demonstratingmore efficient killing. On the other hand, the HLA-A2⁺ leukemia cellline UKE-1 was very effectively lysed by TDO₁₂₃₋₁₃₂ specific T cells,but only scarcely by TDO₃₀₉₋₃₁₇ specific T cells. TDO₁₂₃₋₁₃₂ specific Tcells did not lyse HLA-A2⁺ melanoma cell lines FM-55M1 and FM-86, whichwere efficiently lysed by TDO₃₀₉₋₃₁₇ specific T cells. Finally, theHLA-A2⁻TDO⁺ melanoma cell line A2058 was not lysed by either T-cellline.

TDO Dependent Recognition of Immune Cells

To test whether TDO-specific T cells were able to recognize autologous,mature DC transfected with TDO mRNA, autologous DC, transfected themwith TDO mRNA were generated before analysis in ELISPOT. This experimentrevealed that TDO₃₀₉₋₃₁₇-specific T-cells specifically recognized DCtransfected with TDO (see FIG. 4A). It has previously been shown thatthe TAP-deficient cell line T2 very efficiently process and present longpeptides on the surface on HLA-A2. Two 20 amino acid peptides weresynthesized, which included two of the minimal epitopes (TDO₁₂₃₋₁₃₂(KLLVQQFSIL)(SEQ ID NO:6) and TDO₃₀₉₋₃₁₇(QLLTSLMDI)(SEQ ID NO:9).TDO₁₁₈₋₁₃₇ (VSV ILK LLV QQF SIL ETM TA)(SEQ ID NO:17) includes theepitope TDO₁₂₃₋₁₃₂ and TDO₃₀₃₋₃₂₂ (RFQ VPF QLL TSL MDI DSL MT)(SEQ IDNO:18) includes the epitope TDO₃₀₉₋₃₁₇. It was then analyzed if T2 cellscould cross-present the two long peptides. In this regard, T2-cells wereloaded overnight with either TDO₁₁₈₋₁₃₇ or TDO₃₀₃₋₃₂₂ before they wereused in a standard cytotoxicity assay. As demonstrated in FIG. 4B lysisof T2 cells was observed both when loaded with the short peptide and thecorresponding long peptide, i.e. TDO₁₂₃₋₁₃₂ specific cells lysed T2cells pulsed with TDO₁₂₃₋₁₃₂ peptide or TDO₁₁₈₋₁₃₇ but not when pulsedeither TDO₃₀₉₋₃₁₇ or TDO₃₀₃₋₃₂₂. Hence, the long TDO-derived peptidesare taken up and cross presented in context of HLA-A2 in T2 cells.

CD4⁺ T Cells Recognize TDO

To further scrutinize the immunogenicity of TDO we utilized the two longpeptides TDO₁₁₈₋₁₃₇ and TDO₃₀₃₋₃₂₂ in ELISPOT assays for IFNγ, TNFα,IL-10, and IL-17A (results are shown in FIG. 5). Peptide-specific CD4T-cell responses were present in both cancer patients and healthydonors. Wth respect to IFNy producing CD4⁺ T cells there was nodifference between the 2 cohorts. However, cells producing TNFα inresponse to long TDO peptides were more frequent in healthy donors; forTDO₁₁₈₋₁₃₇ this difference was highly significant (p<0.0001). IL-10 andIL-17 production in response to peptide stimulation was restricted tocancer patients. For TDO₃₀₃₋₃₂₂ these differences were statisticallysignificant (p=0.0051 and p<0.0001, respectively). IL-17 and IL-10,which were only released in response to long TDO peptides by PBMCsobtained from cancer patients, exert profound immune modulatingfunctions and have been implicated with the clinical course of cancerpatients. The frequency of CD4+ T cells producing IL-17A and IL-10 inresponse to the long TDO₃₀₃₋₃₂₂ peptides with the clinical course werecorrelated, which revealed a clear impact of the presence of IL-17 andIL-10 producing cells on the overall survival (OS): Patientscharacterized by CD4+ cells releasing IL-17A had a trend towards animproved OS compared to the non-IL-17A responders (see FIG. 6A); whereaspatients with IL-10 releasing CD4+ T cell in response to the TDOpeptides have an impaired OS (see FIG. 6B). These OS difference was evenmore pronounced when patients harboring either IL-17+/IL-10- orIL-17−/IL-10+ producing T cells were compared. Patients with thepresence of cells producing 17+/IL-10-in response to TDO₃₀₃₋₃₂₂ peptideshad a much better survival (see FIG. 6C).

The present invention discloses that TDO is a target for natural T-cellresponses, which were readily detectable both in cancer patients as wellas in healthy donors. Notably, TDO-specific CD4 and CD8 T-cell responseswere present in health and disease in the same frequency. Thus, healthydonors apparently harbor strong immune responses against theself-protein TDO. Interestingly, however, TDO-specific CD4⁺ T cellsdiffered in their functional characteristics in health and cancer. Inhealthy donors TDO-specific CD4⁺ T cells released TNFα and IFNγ, but notthe regulatory cytokines IL-17 or IL-10. In fact, TDO-specific CD4⁺ Tcells producing TNFα were significantly more frequent in healthy donorsas compared to cancer patients. This indicates that TDO does notnecessarily induce tolerance in healthy individuals.

CD8⁺ and CD4⁺ T cells may exert immune regulatory functions by releaseof cytokines—or even by cytolysis—in response to epitopes derived fromthe immunosuppressive molecule TDO. Hence, both TDO-specific CD8⁺ andCD4⁺ T cells may play a role in the fine-tuning of the immune responseby suppression of the immune permissive state induced by TDO-expressingcells. In cancer patients, however, the phenotype of the CD4⁺TDO-reactive T cells was more complex: In addition to IFNγ and TNFα thecells also produced IL-17 and IL-10 in response to TDO epitopes.Production of IL-17 defines a subset of CD4⁺ T-helper cells (Th17 cells)involved in many pathologic situations including autoimmunity andcancer. Notably, Th17 cells have been attributed a protective roleagainst cancer by promoting antitumor immunity. Tumor-infiltrating Th17cells express other cytokines in addition to IL-17 such as IFNγ, IL-2,and TNF. Notably, some TDO-specific Th17 cells exhibit a similareffector T-cell cytokine profile. Moreover, cancer patients hosting aTDO-specific IL-17 response showed a trend towards an improved OS.

On the other hand, in cancer patients the release of IL-10 in responseto the TDO epitopes was observed. IL-10 is an immunosuppressivecytokine, which is produced among other cells by Tregs. Tregs areimportant to maintain immune homeostasis and to insure tolerance toself-antigens. Thus, TDO-specific Tregs might enhance the TDO-mediatedimmune suppression and thereby boost cancer cells immune escape.Accordingly, patients with IL-10 producing, TDO-reactive CD4⁺ T cellsshowed a trend towards an impaired OS. The OS difference of patientsharboring IL-17+/IL-10−or IL-17−/IL-10+ producing T cells in response toTDO peptides was pronounced

Functional characterization of in vitro expanded CD8⁺ TDO-reactive Tcells revealed that these killed HLA-matched tumor cells of differentorigin.

REFERENCES

Morgan R A, Dudley M E, Wunderlich J R, Hughes M S, Yang J C, Sherry RM, Royal R E, Topalian S L, Kammula U S, Restifo N P, Zheng Z, Nahvi A,de Vries C R, Rogers-Freezer L J, Mavroukakis S A, Rosenberg S A. Cancerregression in patients after transfer of genetically engineeredlymphocytes. Science. 2006 Oct. 6; 314(5796):126-9. Epub 2006 Aug. 31.

Nicolette CA, Healey D, Tcherepanova I, Whelton P, Monesmith T, CoombsL, Finke L H, Whiteside T, Miesowicz F, (2007). Dendritic cells foractive immunotherapy: optimizing design and manufacture in order todevelop commercially and clinically viable products. Vaccine, September27; 25 Suppl 2:B47-60. Epub 2007

Pilotte L, Larrieu P, Stroobant V, Colau D, Dolusic E, Frédérick R, etal. Reversal of tumoral immune resistance by inhibition of tryptophan2,3-dioxygenase. Proc Natl Acad Sci U S A [Internet]. 2012 [cited 2013Apr. 6]; 109:2497-502

Rammensee H, Bachmann J, Emmerich N P, Bachor O a, StevanovićS.SYFPEITHI: database for MHC ligands and peptide motifs. Immunogenetics[Internet]. 1999; 50:213-9.

Sorensen R B, Berge-Hansen L, Junker N, Hansen C A, Hadrup S R,Schumacher T N M, et al. The immune system strikes back: cellular immuneresponses against indoleamine 2,3-dioxygenase. PLoS One [Internet]. 2009[cited 2012 Aug .15]; 4:e6910

Toebes M, Coccoris M, Bins A, Rodenko B, Gomez R, Nieuwkoop N J, et al.Design and use of conditional MHC class I ligands. Nat Med. 2006; 12:246

Walter E A, Greenberg P D, Gilbert M J, Finch R J, Watanabe K S, ThomasE D, Riddell S R (1995). Reconstitution of cellular immunity againstcytomegalovirus in recipients of allogeneic bone marrow by transfer ofT-cell clones from the donor. N Engl J Med. 1995 Oct. 19;333(16):1038-44

Zeeberg Iversen T, Engell-Noerregaard L, Ellebaek E, Andersen R, KiaerLarsen S, Bjoern J, et al. Long-lasting disease stabilization in theabsence of toxicity in metastatic lung cancer patients vaccinated withan epitope derived from indoleamine 2,3 dioxygenase. Clin cancer Res[Internet]. 2013 [cited 2013 Nov. 14]

1. A vaccine composition comprising a) one or more of the following: (i)tryptophan 2,3-dioxygenase (TDO) of SEQ ID NO:1; (ii) an immunogenicallyactive peptide fragment of TDO comprising a consecutive sequence ofamino acids of TDO of SEQ ID NO:1; (iii) an immunogenially activepeptide fragments of TDO, which is an MHC Class I-restricted peptidefragment or MHC Class II-restricted peptide fragment; (iv) a functionalhomologue of the polypeptides under (i), (ii) and (iii), wherein saidfunctional homologue shares at least 70% sequence identity with SEQ IDNO:1 and/or said functional homologue is an immunogenically activepolypeptide consisting of a sequence identical to a consecutive sequenceof amino acids of SEQ ID NO:1, except that at the most three amino acidshave been substituted; (v) a polypeptide comprising any of thepolypeptides under (i), (ii), (iii) or (iv); (vi) a nucleic acidencoding any of the polypeptides under 1), 2), 3) and 4); and b) anadjuvant for use as a medicament.
 2. The vaccine composition accordingto claim 1, wherein said vaccine compositions comprises mutant TDO ofSEQ ID NO:1, wherein one or more of the amino acids 144, 151, 328 and/or342 have been mutated to another amino acid or are deleted or animmunogenically active peptide fragment thereof.
 3. The vaccinecomposition according to any one of claims 1 to 2, wherein saidimmunogenically active peptide fragment consists of a consecutivesequence of in the range of from 5 to 50 amino acids.
 4. The vaccinecomposition according to any of the preceding claims, wherein saidimmunogenically active peptide fragment is a) a consecutive sequence inthe range of 8 to 11 amino acids of SEQ ID NO:1 and/or b) a consecutivesequence of in the range of 18 to 30 amino acids of SEQ ID NO:1 or c) afunctional homologue of a) or b) wherein at the most two amino acid havebeen substituted.
 5. The vaccine composition of according to any of thepreceding claims, wherein the vaccine composition is capable ofeliciting an immune response against a cancer and/or an antigenpresenting cell expressing TDO of SEQ ID NO: 1 or a functional homologuesharing at least 70% sequence identity therewith, when administered toan individual suffering from a clinical condition characterized byexpression of TDO.
 6. The vaccine composition according to any of thepreceding claims, wherein said vaccine composition is capable ofeliciting a cellular immune response in the individual.
 7. The vaccinecomposition according to any of the preceding claims, wherein saidvaccine composition is capable of eliciting a cellular immune responsespecifically recognising cells expressing TDO in the individual.
 8. Thevaccine composition according to any of the preceding claims, whereinsaid medicament is for treatment or prophylaxis of cancer.
 9. Thevaccine composition according to any of claims 1 to 7, wherein saidmedicament is for treatment of an infection.
 10. The vaccine compositionaccording to any of the preceding claims, comprising an MHC ClassI-restricted peptide having at least one of the followingcharacteristics: a) capable of eliciting INF-γ-producing cells in a PBLpopulation of an individual suffering from a clinical condition at afrequency of at least 1 per 10⁴ PBLs as determined by an ELISPOT assay,and/or b) capable of in situ detection in a tumor tissue of CTLs thatare reactive with the epitope peptide. c) capable of inducing the growthof TDO specific T-cells in vitro.
 11. The vaccine composition accordingto any of the preceding claims, comprising a peptide fragment, which isrestricted by a MHC Class I molecule.
 12. The vaccine compositionaccording to any of the preceding claims, comprising a peptide fragment,which is restricted by a MHC Class II molecule.
 13. The vaccinecomposition according to any of the preceding claims comprising apeptide fragment that is capable of eliciting INF-γ-producing cells in aPBL population of an individual suffering from a clinical condition at afrequency of at least 10 per 10⁴ PBLs.
 14. The vaccine compositionaccording to any of the preceding claims comprising a peptide fragment,which is capable of eliciting INF-γ-producing cells in a PBL populationof an individual suffering from a clinical condition where TDO of SEQ IDNO 1 or a functional homologue thereof having at least 70% identity toSEQ ID 1 is expressed.
 15. The vaccine composition according to any ofclaims 8 and 10 to 14, where the cancer disease is a tumor formingcancer disease.
 16. The vaccine composition according to any of thepreceding claims, wherein the peptide fragment consists of at the most50 amino acid residues, for example at the most 45 amino acid residues,such as at the most 40 amino acid residues, for example at the most 35amino acid residues, such as at the most 30 amino acid residues, forexample at the most 25 amino acid residues, such as 20 to 25 amino acidresidues.
 17. The vaccine composition according to any of the precedingclaims, wherein the peptide fragment consists of at the most 20 aminoacid residues, for example at the most 19 amino acid residues, such asat the most 18 amino acid residues, for example at the most 17 aminoacid residues, such as at the most 16 amino acid residues, for exampleat the most 15 amino acid residues, such as at the most 14 amino acidresidues, for example at the most 13 amino acid residues, such as at themost 12 amino acid residues, for example at the most 11 amino acidresidues, such as 8 to 10 amino acid residues.
 18. The vaccinecomposition according to any of the preceding claims, wherein thepeptide fragment is selected from the group of SEQ ID NO: 3, SEQ IDNO:6, SEQ ID NO: 9, SEQ ID NO:13, SEQ ID NO:17, SEQ ID NO:18 andfunctional homologues of any of the aforementioned, said functionalhomologue being a polypeptide of identical sequence except that at themost three amino acids have been substituted.
 19. The vaccinecomposition according to any of the preceding claims, wherein thepeptide fragment is SEQ ID NO: 6 and/or
 9. 20. The vaccine compositionaccording to any one of claims 1 to 17, wherein the peptide fragment isSEQ ID NO:17 and/or
 18. 21. The vaccine composition according to any oneof claims 1 to 15, wherein said polypeptide is a polypeptide of at themost 100 amino acids, such as at the most 80 amino acids, for example atthe most 60 amino acids, such as at the most 40 amino acids, for exampleat the most 30 amino acids comprising a consecutive sequence of aminoacids of SEQ ID NO:1.
 22. The vaccine composition according to 1 to 16,wherein said polypeptide is a polypeptide of at the most 20 amino acids,for example at the most 15 amino acids comprising a consecutive sequenceof amino acids of SEQ ID NO:1
 23. The vaccine composition according toany one of claims 1 to 15, wherein said polypeptide is a polypeptide ofat the most 100 consecutive amino acids, such as at the most 80consecutive amino acids, for example at the most 60 consecutive aminoacids, such as at the most 40 consecutive amino acids, for example atthe most 30 consecutive amino acids, such as at the most 20 consecutiveamino acids, for example at the most 15 consecutive amino acids of SEQID NO:1 except that up to three amino acids may be substituted, whereinthe polypeptide comprises a sequence selected from the group consistingof SEQ ID NO: 3, SEQ ID NO:6, SEQ ID NO: 9, SEQ ID NO:13, SEQ ID NO:17and SEQ ID NO:18.
 24. The vaccine composition according to any one ofclaims 21 to 23, wherein said consecutive sequence of amino acids isselected from the group consisting of SEQ ID NO:3, SEQ ID NO:6, SEQ IDNO:9, SEQ ID NO:13 and functional homologues of any of theaforementioned, said functional homologue being a polypeptide ofidentical sequence except that at the most three amino acids have beensubstituted.
 25. The vaccine composition according to claim 21, whereinsaid consecutive sequence of amino acids is selected from the groupconsisting of SEQ ID NO:17, SEQ ID NO:18 and functional homologues ofany of the aforementioned, said functional homologue being a polypeptideof identical sequence except that at the most three amino acids havebeen substituted.
 26. The vaccine composition according to any of thepreceding claims, where the vaccine elicits the production in avaccinated individual of regulatory T-cells having a cytotoxic effectagainst the TDO expressing cancer cells and/or TDO expressing antigenpresenting cells.
 27. The vaccine composition according to any of thepreceding claims, wherein the vaccine composition is capable ofeliciting a clinical response in a subject, wherein the clinicalresponse is characterised by a stable disease, a partial response orcomplete remission.
 28. The vaccine composition according to any of thepreceding claims, further comprising an immunogenically active proteinor peptide fragment selected from a protein or peptide fragment, whichis not TDO.
 29. The vaccine composition according to any of thepreceding claims, wherein the adjuvant is selected from the groupconsisting of bacterial DNA based adjuvants, oil/surfactant basedadjuvants, viral dsRNA based adjuvants and imidazochinilines.
 30. Thevaccine composition according to any of the preceding claims, whereinthe adjuvant is a Montanide ISA adjuvant.
 31. The vaccine compositionaccording to claim 28, wherein the adjuvant is Montanide ISA 51 orMontanide ISA
 720. 32. The vaccine composition according to claim 30,wherein the adjuvant is Montanide ISA 51
 33. The vaccine compositionaccording to any of claims 1 to 29, wherein the adjuvant is GM-CSF 34.The vaccine composition according to any of the preceding claims,wherein the vaccine composition comprises antigen presenting cellscomprising the immunogenically active peptide fragment or a nucleic acidencoding said immunogenically active peptide fragment.
 35. The vaccinecomposition according to claim 34, wherein the antigen presenting cellis a dendritic cell.
 36. The vaccine composition according to claim 1,wherein the nucleic acid encodes the peptide as defined in any of claims2 to 4 and 10 to
 25. 37. The vaccine composition according to any ofclaim 1 or 36, wherein the nucleic acid is comprised within a vector.38. The vaccine composition according to claim 37, wherein the vector isselected from the group consisting of viral vectors and bacterialvectors.
 39. The vaccine composition according to any of claim 37 or 38,wherein the vector furthermore comprises nucleic acids encoding a T-cellstimulatory polypeptide.
 40. The vaccine composition according to anyone of claims 1 to 39, wherein said vaccine composition is for treatmentof a cancer disease where TDO is expressed.
 41. The vaccine compositionaccording to any one of claims 1 to 39, wherein the vaccine compositionis for treatment of an inflammation causing TDO expression in APCs. 42.A kit-of-parts comprising the vaccine composition according to any ofclaims 1 to 39, and a second active ingredient.
 43. The kit-of-partscomprising the vaccine composition according to claim 42, wherein thesecond active ingredient is an immunostimulating composition.
 44. Thekit-of-parts according to any of claim 42 or 43, wherein the furtherimmunostimulating composition comprises one or more interleukins. 45.The kit-of-parts according to any of claims 42 to 44, wherein theinterleukins are selected from IL-2 and or IL-21.
 46. The kit-of-partscomprising the vaccine composition according to any of claims 1 to 39,wherein the second active ingredient is an anti-cancer agent.
 47. Thekit-of-parts according to claim 46, wherein the anti-cancer agent is achemotherapeutic agent.
 48. The kit-of-parts according to any of claim46 or 47, wherein the chemotherapeutic agent is selected from: Actimide,Azacitidine, Azathioprine, Bleomycin, Carboplatin, Capecitabine,Cisplatin, Chlorambucil, Cyclophosphamide, Cytarabine, Daunorubicin,Docetaxel, Doxifluridine, Doxorubicin, Epirubicin, Etoposide,Fludarabine, Fluorouracil, Gemcitabine, Hydroxyurea, Idarubicin,Irinotecan, Lenalidomide, Leucovorin, Mechlorethamine, Melphalan,Mercaptopurine, Methotrexate, Mitoxantrone, Oxaliplatin, Paclitaxel,Pemetrexed, Revlimid, Temozolomide, Teniposide, Thioguanine, Valrubicin,Vinblastine, Vincristine, Vindesine and Vinorelbine.
 49. Thekit-of-parts comprising the vaccine composition according to any ofclaims 1 to 39, wherein the second active ingredient is an antibiotic.50. The kit-of-parts comprising the vaccine composition according toclaim 49, wherein the antibiotic is selected from: amoxicillin,penicillin, acyclovir and/or vidarabine.
 51. The kits-of-parts accordingto any of claims 42 to 50, where the provided compositions are to beadministered simultaneously or sequentially.
 52. A composition for exvivo or in situ diagnosis of the presence in an individual sufferingfrom a clinical condition of T cells in PBL or in tumor tissue that isreactive with TDO, the composition comprising a peptide fragment asdefined in any of claims 1 to 4 and 10 to
 25. 53. A diagnostic kit forex vivo or in situ diagnosis of the presence in an individual sufferingfrom a clinical condition of T cells in PBL or in tumor tissue that isreactive with TDO, the kit comprising a peptide fragment as defined inany of claims 1 to 4 and 10 to
 25. 54. A complex of a peptide fragmentas defined in any of claims 1 to 4 and 10 to 25 and a Class I HLA or aClass II HLA molecule or a fragment of such molecule.
 55. The complex ofclaim 54 which is monomeric.
 56. The complex of claim 54 which ismultimeric.
 57. A method of detecting in an individual suffering from aclinical condition the presence of TDO reactive T-cells, the methodcomprising contacting a tumor tissue or a blood sample with a complex ofclaim 52 and detecting binding of the complex to the tissue or the bloodcells.
 58. A molecule that is capable of binding specifically to apeptide fragment as defined in any of claims 1 to 4 and 10 to
 25. 59.The molecule of claim 58, which is an antibody or a fragment hereof. 60.The molecule according to any of claim 58 or 59, wherein the molecule isa T-cell receptor.
 61. A molecule that is capable of blocking thebinding of the molecule of claims 58 to
 60. 62. A method of treating orreducing the risk of aquiring a clinical condition characterized by theexpression of TDO, the method comprising administering to an individualsuffering from said clinical condition an effective amount of thecomposition according to any of claims 1 to 39, the molecule of any oneof claims 58 to 61 or the kit-of-parts according to any of claims 42 to51.
 63. The method of claim 62 wherein the clinical condition to betreated is a cancer disease where TDO is expressed.
 64. The method of toclaim 62, which is combined with a further cancer treatment.
 65. Themethod of claim 64, wherein the further treatment is selected from thegroup consisting of chemotherapy, radiotherapy, treatment withimmunostimulating substances, gene therapy, treatment with antibodiesand treatment using dendritic cells.
 66. The method of claim 62, whereinthe clinical condition to be treated is an infection causing TDOexpression in APCs.
 67. The method of claim 66, which is combined with afurther treatment against said infection.
 68. The method of claim 67,wherein the further treatment is selected from the group consisting ofchemotherapy, treatment with immunostimulating substances, gene therapy,treatment with antibodies and treatment using dendritic cells.
 69. Themethod according to any one of claims 62 to 68, wherein the TDO or theimmunogenically active peptide fragment of TDO is administered at adosis of in the range of 50 μg to 500 μg, for example in the range of 80μg to 300 μg, such as in the range of 100 μg to 250 μg per individual,wherein the individual preferably is a human being.
 70. Use of thevaccine composition according to any of claims 1 to 39, the kit-of-partsaccording to any one of claims 42 to 50, or the molecule according toany one of claims 58 to 61 in the manufacture of a medicament for thetreatment or prevention of a clinical condition.
 71. The use of claim 70wherein the disease to be treated is a cancer disease where TDO isexpressed.
 72. The use according to any of claim 70 or 71, which iscombined with a further cancer treatment.
 73. The use of claim 72,wherein the further treatment is selected from the group consisting ofchemotherapy, radiotherapy, treatment with immunostimulating substances,gene therapy, treatment with antibodies and treatment using dendriticcells.
 74. The use of claim 70 wherein the clinical condition to betreated is an infection causing TDO expression in APCs.
 75. The use ofclaim 74, which is combined with a further treatment against saidinfection.
 76. The use of claim 74, wherein the further treatment isselected from the group consisting of chemotherapy, treatment withimmunostimulating substances, gene therapy, treatment with antibodiesand treatment using dendritic cells.
 77. A method of monitoringimmunization, said method comprising the steps of a) providing a bloodsample from an individual b) providing TDO of SEQ ID NO:1 or afunctional homologue thereof having at least 70% identity thereto or animmunogenically active peptide fragment comprising a consecutivesequence of said TDO or said functional homologue thereof or a nucleicacid encoding said TDO or said peptide fragment. c) determining whethersaid blood sample comprises antibodies or T-cells comprising T-cellreceptors specifically binding the protein or peptide d) therebydetermining whether an immune response to said protein or peptide hasbeen raised in said individual.
 78. The method according to claim 77,wherein the peptide fragment is a peptide fragment as defined in any oneof claims 1 to 4 and 10 to
 25. 79. An immunogenically active TDO peptidefragment comprising a consecutive sequence of TDO of SEQ ID NO:1 or afunctional homologue thereof, said functional homologue being apolypeptide of identical sequence except that at the most three aminoacids have been substituted, or a nucleic acid encoding said TDO peptidefragment for use in the treatment or prevention of clinical conditionsassociated with expression of TDO, such as cancer and/or inflammation.80. The peptide fragment according to claim 79, wherein the peptidefragment is as defined in any one of claims 2 to 4 and 10 to
 25. 81. Thepeptide fragment according to any of claims 79 and 80 for use in thetreatment or prevention of cancer.